Salmonella osteomyelitis. An important differential diagnosis of granulomatous osteomyelitis.

A case of septicemia owing to Salmonella choleraesuis with localization in the lumbar spine and left knee is described. The spinal lesion is dominated by tuberculoid granulomas with or without central necrosis. The necrotic foci within some granulomas show heavy polymorph infiltration, whereas in others they simulate caseous necrosis and are indistinguishable histologically from tuberculosis, brucellosis, and fungal infections. As Salmonella osteomyelitis has a strong tendency to chronicity if antimicrobial treatment is delayed, inappropriate, or inadequate, this diagnosis should be considered in all cases of granulomatous osteomyelitis, especially when the patient is immunosuppressed or has hemoglobinopathy.