Journal List > Korean J Clin Microbiol > v.13(3) > 1038193

Korean J Clin Microbiol. 2010 Sep;13(3):132-134. English.
Published online September 30, 2010.  https://doi.org/10.5145/KJCM.2010.13.3.132
Copyright © 2010 The Korean Society of Clinical Microbiology
Brodie's Abscess Caused by Salmonella enteritica serovar Senftenberg in a Healthy Child
Nam Hee Ryoo,1 Jung Sook Ha,1 and Kwang Soon Song2
1Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea.
2Department of Orthopedics, Keimyung University School of Medicine, Daegu, Korea.

Correspondence: Nam Hee Ryoo, Department of Laboratory Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. (Tel) 82-53-250-7950, (Fax) 82-53-250-7275, Email: nhryoo@dsmc.or.kr
Received May 11, 2010; Revised May 31, 2010; Accepted June 18, 2010.

Abstract

Salmonella enteritica serovar Senftenberg is a rare pathogen in osteomyelitis, and is not usually encountered in healthy individuals. Here we report radiological and microbiological findings of a case of Brodie's abscess caused by S. enteritica serovar Senftenberg in the left tibia of an otherwise healthy child.

Keywords: Salmonella enteritica; Osteomyelitis; Brodie's abscess

INTRODUCTION

Infections caused by Salmonella enteritica serovar Senftenberg is a rare condition without any underlying disorders[1, 2]. A case of Brodie's abscess caused by S. enteritica serovar Senftenberg in an otherwise healthy child who complained of left ankle panin for 3 months without any historic events. The authors reviewed the rarity of this causative pathogen with clinical and radiological findings.

CASE REPORT

A 13-year-old girl presented in a local clinic with intermittent left ankle pain for 3 months without any history of trauma. She often had discomfort in walking but with no altered sensation or swelling. The patient was transferred to our hospital for the persistent pain in her left ankle. Fever and other constitutional symptoms were absent at presentation. There was no family history of specific illness and no evidence of any underlying diseases. A physical examination revealed swelling and mild tenderness of her left ankle. She had no systolic murmur or other specific findings. She undertook simple radiography and magnetic resonance imaging (MRI).

Preoperatively, blood examination revealed a leukocyte count of 6.0×109/L (reference range, 4.0~10.0×109/L) with neutrophils in 54%, a hemoglobin level of 12.5 g/dL (reference range, 12~14 g/dL) and a platelet count of 398×109/L (reference range, 140~450×109/L). C-reactive protein level was at 0.08 mg/dL (reference range, 0~0.5 mg/dL), and an erythrocyte sedimentation rate at 6 mm/hr (reference range, <25 mm/hr). A preoperative simple radiography of lower extremity showed well-defined lytic lesion in the metadiaphyseal region of the left distal tibia (Fig. 1). MRI of the left ankle using T1-weighted and T2-weighted MRI showed a well-defined and bilobed intramedullary cystic lesion in metadiaphysis of left distal tibia about 18 mm in diameter and 40 mm in length. This lesion revealed uniform rim enhancement, marrow edema and thin periosteal reaction, and no definite cortical disruption nor soft tissue mass was noted (Fig. 2). A percutaneous needle biopsy of the lesion showed an intracortical lytic lesion with a tiny, hyperdense focus at its center and revealed chronic inflammatory tissue reaction.


Fig. 1
Plain radiographs of the left ankle showing lytic lesion in metadiaphysis of left distal tibia (anteroposterior (A) and lateral (B) views).
Click for larger image


Fig. 2
Coronal T1 (A) and T2-weighted (B) magnetic resonance images of the left ankle showing a well-defined and bilobed intramedullary cystic lesion in metadiaphysis of left distal tibia about 18 mm in diameter and 40 mm in length.
Click for larger image

She underwent a surgery for the debridement of Brodie's abscess. Aspirates of abscess during the operation were cultured sequentially and yielded Salmonealla spp., group E by performing Gram stain, Salmonella/Shigella and triple sugar iron agar findings, and antisera grouping with no other pathogenic colonies. S. enterica serovar Senftenberg was finally identified by conventional and molecular identification methods at the Institute of Health and Environment in Daegu. Antimicrobial susceptibility test was done by VITEK system (bioMérieux VITEK, Hazelwood, MO, USA) and revealed susceptible to ampicillin, cefotaxime and ciprofloxacin except trimethoprim-sulfamethoxazole. The infection was successfully treated with operational curettage and intravenous cefotaxime. After 2 weeks of the treatment, cefotaxime was changed to per oral and she returned to outpatient clinic.

DISCUSSION

Bone and joint infections caused by Salmonella spp. are infrequent with less than 1% of occurrence[2-6]. Salmonella osteomyelitis is usually associated with hemoglobinopathies and other diseases with immunosuppression[3-5]. However, it occasionally has been occurred in healthy or immunocompromised patients with no history of underlying above diseases[5-7]. Salmonella Typhi is the most frequent isolate in these infections[3, 4]. Infections by rare nonenterical salmonella spp. in developing countries are common due to overcrowding, frequent breakdown of antiseptic practices and overuse and misuse of antimicrobials[1].

Brodie's abscess is defined as a form of osteomyelitis with clinical, radiological and pathological findings[8-10]. It is a form of osteomyelitits and first reported by Brodie in the tibia in 1836. Brodie's abscess usually involve the medulla accounting about 85% and 14% in the cortex[10]. It has gradual onset mostly with pain only for several weeks to months. Laboratory findings are usually nonspecific and not referring to any inflammatory events[11]. The etiologic pathogen of Brodie's abscess is mostly Staphylococcus aureus but sterile cultures were found in about 25%[2, 9, 10]. Our patient was previously an otherwise healthy child, but we did not have a chance to screen for the Salmonella carriage in stool culture. In the review of present illness, she did not complaint for any gastrointestinal events suggesting prior infection of Salmonella. During the time of the culture of this case in the laboratory, there wasn't any isolation of S. enterica serovar Senftenberg. Also we never had any isolation of S. enterica serovar Senftenberg in the laboratory at all confirming that our laboratory including the technicians was not the source of this organism. The treatment of Brodie's abscess is usually combined with surgical removal of the abscess with antimicrobial therapy[7, 8, 11]. As in our case, Brodie's abscess in left tibia was successfully treated with surgical debridement and appropriate antibiotics.

There wasn't any report of Brodie's abscess caused by S. enterica serovar Senftenberg in Korea yet. An outbreak of food poisoning in 104 patients by this organism has been reported in 1998[12]. Therefore, we report the first case of Brodie's abscess by S. enterica serovar Senftenberg in Korea.

An infection caused by Salmonella enterica serovar Senftenberg is a rare condition in healthy person, and S. enterica serovar Senftenberg is also a rare pathogen in osteomyelitis. A case of Brodie's abscess caused by S. enterica serovar Senftenberg in a healthy child is reported. This patient initially presented with an intermittent left ankle pain for 3 months without any history of trauma. Plain radiograph and mangnetic resonance image of left ankle revealed an abscess formation with chronic osteomyelitis around left distal tibia and diagnosed as Brodie's abscess. S. enterica serovar Senftenberg was found out to be the causative organism with the culture of abscess aspirates. The infection was successfully treated with operational curettage and intravenous cefotaxime.

ACKNOWLEDGEMENTS

We would like to thank Mr. Jae Yeul Hyun of the Institute of Health and Environment for the support of the identification of S. enterica serovar Senftenberg.

References
1. Dravid MN, Joshi BN, Gokhale VS, Rajput AG. Osteomyelitis: a rare complications of Salmonella senftenberg infection--a case report. Indian J Med Sci 1989;43:239–240.
2. Resnick D, Niwayama G. Osteomyelitis, Septic arthritis, and Soft Tissue Infection: Mechanisms and Situations. In: Resnick D, editor. Diagnosis of Bone and Joint Disorders. 3rd ed. Philadelphia: WB Saunders Company; 1995. pp. 2325-2418.
3. Cobos JA, Calhoun JH, Mader JT. Salmonella typhi osteomyelitis in a nonsickle cell patient. A case report. Clin Orthop Relat Res 1993;288:277–281.
4. Carlson DA, Dobozi WR. Hematogenous Salmonella typhi osteomyelitis of the radius. A case report. Clin Orthop Relat Res 1994;308:187–191.
5. van Cappelle HG, Veenendaal D, de Vogel PL. Salmonella panama osteomyelitis in an otherwise healthy patient. A case report. Clin Orthop Relat Res 1995;321:235–238.
6. Sucato DJ, Gillespie R. Salmonella pelvic osteomyelitis in normal children: report of two cases and a review of the literature. J Pediatr Orthop 1997;17:463–466.
7. Arora A, Singh S, Aggarwal A, Aggarwal PK. Salmonella osteomyelitis in an otherwise healthy adult male-successful management with conservative treatment: a case report. J Orthop Surg (Hong Kong) 2003;11:217–220.
8. van Wiechen PJ, de Smet WE. A Brodie's abscess caused by Salmonella give. Diagn Imaging Clin Med 1984;53:315–316.
9. Stephens MM, MacAuley P. Brodie's abscess. A long-term review. Clin Orthop Relat Res 1988;234:211–216.
10. Lopes TD, Reinus WR, Wilson AJ. Quantitative analysis of the plain radiographic appearance of Brodie's abscess. Invest Radiol 1997;32:51–58.
11. Ip KC, Lam YL, Chang RY. Brodie's abscess of the ulna caused by Salmonella typhi. Hong Kong Med J 2008;14:154–156.
12. Eom KS, Lee JM, Lee IS, Moon JS, Kim MY, Kim YR, et al. An outbreak of food poisoning by Salmonella senftenberg. Korean J Infect Dis 1998;30:571–574.