Systemic leptospirosis followed by salmonella vertebral osteomyelitis without sickling or immunosuppression.

STUDY
DESIGN: The clinical history of a healthy young patient who acquired systemic leptospirosis followed by salmonella vertebral osteomyelitis was studied in detail, and compared to the histories of leptospirosis and salmonella vertebral osteomyelitis reported in the literature.
OBJECTIVE: To alert the medical community about this unusual association of infectious diseases in a healthy patient without sickling or immunosuppression. SUMMARY OF BACKGROUND DATA: Human leptospirosis has been intensively studied, and there are several reports of salmonella vertebral osteomyelitis in patients without sickling. However, the combination of these entities in a single healthy patient is unexpected.
METHODS: The extensive literature on human leptospirosis and salmonella vertebral osteomyelitis was reviewed in detail, in correlation with this patient's clinical history and imaging studies.
RESULTS: The patient had no previous medical history. He contracted systemic leptospirosis when swimming in a lake contaminated with the urine of infected animals. As his leptospirosis symptoms resolved with doxycycline, he experienced increasing thoracolumbar spine pain, because of salmonella vertebral osteomyelitis, which responded to amoxicillin.
CONCLUSION: Leptospirosis may have caused gut mucosal vasculitis, allowing salmonella to enter the bloodstream and infect the spine.