Nontyphoidal Salmonella pyomyositis and osteomyelitis in a healthy infant

A healthy male infant presented with right upper extremity pseudoparalysis and fever 2 weeks after gastroenteritis caused by nontyphoidal Salmonella. Following hospitalisation for treatment of right deltoid pyomyositis caused by Salmonella enterica serovar Enteritidis with intravenous antibiotics, he was subsequently re-admitted when an MRI scan identified new osteomyelitis of the proximal right humerus, an associated abscess within the bone and persistent pyomyositis of the right deltoid. He was managed with surgical irrigation and debridement, followed by a 6-week course of parenteral antibiotics. Osteoarticular infections with suppurative complications caused by Salmonella species are extremely rare in immune-competent infants. Risk factors for Salmonella infections include sick contacts, residing in a rural area, recent travel to regions of high exposure and reptile exposure. Invasive nontyphoidal Salmonellosis should be considered in children with musculoskeletal complaints after recent Salmonella gastrointestinal infections. Treatment may require both surgical source control and 4-6 weeks of antibiotic therapy.