Salmonella osteomyelitis in new-onset diabetes mellitus.

Salmonella species are rare bacterial isolates in osteomyelitis. This article describes a case of an otherwise healthy, active duty male military member with an insidious onset of right knee pain during a deployment to Kuwait. His work-up revealed an infectious process in the distal femur. Operative treatment and intravenous antibiotics resolved the infection. Intraoperative cultures revealed the rare isolate Salmonella enterica serotype C2 (Newport). Postoperative medical management revealed new-onset diabetes mellitus, possibly making this otherwise healthy host susceptible to this rare infection. Salmonella are gram-negative bacteria. Infection with nontyphoidal Salmonella species most commonly manifests as intestinal illness. Although it may be difficult for clinicians to accurately predict this rare entity as the causative organism in osteomyelitis, they may be aided by a history of travel to endemic regions or exposure to animal carriers. Comorbidities that seem to increase susceptibility include diabetes mellitus, human immunodeficiency virus, hemoglobinopathies, and immunosuppression. Blood cultures are reported to be frequently positive in cases of Salmonella osteomyelitis. Identification of Salmonella species from intraoperative cultures should prompt consultation with the infectious disease department for culture-specific antibiotic tailoring. Many common antibiotic agents active against gram-negative organisms seem efficacious. As in this case, following the basic tenets of osteomyelitis management should lead to an acceptable outcome.