Salmonella Typhi Leg Abscess in a Patient with Myelodysplastic Syndrome
Abstract
We describe a 59-year-old Filipino male patient with myelodysplastic syndrome (MDS) who developed a Salmonella typhi leg abscess, presenting with a two-week history of right leg swelling and fever. The infection was treated successfully with a combination of surgical drainage and a three-week course of intravenous antibiotics. MDS predisposes patients to severe Salmonella infections ranging from infected subdural empyema to aortitis, empyema thoracis and splenic abscesses. To our knowledge, this is the first reported case of S. typhi soft tissue abscess in MDS. Salmonella infections should be considered in the differential diagnosis of soft tissue abscesses, especially among immunocompromised patients such as patients with MDS.
References
1) Kan M, Kim T, Miyaichi T, Rinka H, Matsuo Y, Shigemoto T, Yoshimura T, Kaji A, Tsukioka K, Ukai T, Nishikawa M, Yamanaka K. A case of Salmonella subdural empyema developed in chronic subdural hematoma. No Shinkei Geka. 1998 Oct;26(10):903-7.
2) Soravia-Dunand VA, Loo VG, Salit IE. Aortitis Due to Salmonella: Report of 10 Cases and Comprehensive Review of the Literature. Clinical Infectious Diseases 1999;29:862–8.
3) Roguin A, Gavish I, Ben Ami H, Edoute Y. Pleural empyema with Salmonella mendoza following splenic abscesses in a patient with myelodysplastic syndrome. The Israel Medical Association journal .1999 Nov;1(3):195-6.
4) Murdoch MB, Peterson LR. Nontyphoidal Salmonella Pleuropulmonary Infections. Arch Intern Med. 1991;151(1):196. doi:10.1001/archinte.1991.00400010178029.
5) Aleali SH, Castro O, Spencer RP, Finch SC. Sideroblastic Anemia with Splenic Abscess and Fatal Thromboemboli after Splenectomy. Ann Intern Med. 1975;83(5):661-663. doi:10.7326/0003-4819-83-5-661
6) Shamiss A, Thaler M, Nussinovitch N, Zissin R, Rosenthal T. Multiple Salmonella enteritidis leg abscesses in a patient with systemic lupus erythematosus. Postgrad Med J (1990) 66, 486 – 488.
7) Cistulli PA, Barnes DJ, Young GA. Salmonella empyema in a patient with lymphoma. Australian and New Zealand Journal of Medicine. 1991;21(2):246–247.
8) Akkoyunlu Y, Ceylan B, Iraz M, Elmadag NM, Aslan T. Muscle Abscess due to Salmonella Enterica. Iran Red Crescent Med J. 2013 July; 15(7):605–607. doi: 10.5812/ircmj.6852
9) Collazos J, Mayo J, Martínez E, Blanco MS. Muscle infections caused by Salmonella species: case report and review. Clin Infect Dis. 1999 Sep;29(3):673-7.
10) Toma A, Fenaux P, Dreyfus F, Cordonnier C. Infections in myelodysplastic syndromes. Haematologica 2012;97(10):1459-1470. doi:10.3324/haematol.2012.063420
11) Dayyani F, Conley AP, Strom SS, Stevenson W, Cortes JE, Borthakur G, et al. Cause of death in patients with lower-risk myelodysplastic syndrome. Cancer. 2010;116(9):2174-9.
12) Cunningham I, MacCalum SJ, Nicholls MD, Byth K, Hewson JW, Arnold B, et al. The myelodysplastic syndromes: an analysis of prognostic factors in 226 cases from a single institution. Br J Haematol. 1995;90(3):602-6.
13) Ganser A, Hoelzer D. Clinical course of myelodysplastic syndromes. Hematol Oncol Clin North Am. 1992;6(3):607-18.
14) Mufti GJ, Galton DAG. Myelodyslastic syndrome natural history and features of prognostic significance. Clin Haematol. 1986;15(4):953-69.
15) Marisavljevic’ D, Kraguljac N, Rolovic’ Z. Immunologic abnormalities in myelodysplastic syndromes: clinical features and characteristics of the lymphoid population. Med Oncol. 2006;23(3):385-91.
16) Katsuki K, Shinohara K, Kameda N, Yamada T, Takeda K, Kamei T. Two cases of myelodysplastic syndrome with extramedullary polyclonal plasma cell proliferation and autoantibody production: possible role of soluble Fas antigen for production of excessive self-reactive B cells. Intern Med. 1998;37(11):973-7.
17) Okamoto T, Okada M, Mori A, Saheki K, Takatsuka H, Wada H, et al. Correlation between immunological abnormalities and prognosis in myelodysplastic syndrome patients. Int J Hematol. 1997;66(3):345-51.
18) Shioi Y, Tamura H, Yokose N, Satoh C, Dan K, Ogata K. Increased apoptosis of circulating T cells in myelodysplastic syndromes. Leuk Res. 2007;31(12):1641-8.
19) Kiladjian J, Bourgeois E, Lobe I, Braun T, Visentin G, Bourhis J, et al. Cytolytic function and survival of natural killer cells are severely altered in myelodysplastic syndromes. Leukemia. 2006;20(3):463-70.
20) Epling-Burnette P, Bai F, Painter J, Rollison D, Salih H, Krusch M, et al. Reduced natural killer (NK) function associated with high-risk myelodysplastic syndrome (MDS) and reduced expression of activating NK receptors. Blood. 2007;109(11):4816-24.
21) Lee JH, Lee KH, Lee JH, Kim DY, Kim SH, Lim SN, et al. Decreased incidence of febrile episodes with antibiotic prophylaxis in the treatment of decitabine for myelodysplastic syndrome. Leuk Res. 2011;35(4):499-503.
22) Mele L, Ricci P, Nosari A, Tonso A, Fianci L, Cudillo L, et al. Invasive fungal infection in patients with myelodysplastic syndrome: a report of twelve cases. Leuk Lymphoma. 2002;43(8):1613-7.
23) Acharya D, Trakulsomboon S, Madhup SK, Korbsrisate S. Antibiotic susceptibility pattern and the indicator of decreased ciprofloxacin susceptibility of Salmonella enterica serovar Typhi isolated from Dhulikhel Hospital, Nepal. Jpn J Infect Dis. 2012;65(3):264-7.
24) Chau TT, Campbell JI, Galindo CM, et al. Antimicrobial drug resistance ofSalmonella enterica serovar Typhi in Asia and molecular mechanism of reduced susceptibility to the fluoroquinolones. Antimicrob. Agents Chemother.2007;51:4315–4323.
25) Khanal B, Sharm SK, Bhattacharya SK, et al. Antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi in Eastern Nepal. J. Health Popul. Nutr. 2007;25:82–87.
26) Madhulika U, Harish BN, Parija SC. Current pattern in antimicrobial susceptibility of Salmonella Typhi isolates in Pondicherry. Indian J. Med. Res. 2004;120:111–114.
27) Asna SM, Haq JA, Rahman MM. Nalidixic acid-resistant Salmonella enterica serovar Typhi with decreased susceptibility to ciprofloxacin caused treatment failure: a report from Bangladesh. Jpn. J. Infect. Dis. 2003;56:32–33.
28) Antimicrobial Resistance Surveillance Reference Laboratory. Antimicrobial Resistance Surveillance Program 2012 Data Summary Report. Manila: Department of Health, Research Institute for Tropical Medicine, ARSP, 2012.
2) Soravia-Dunand VA, Loo VG, Salit IE. Aortitis Due to Salmonella: Report of 10 Cases and Comprehensive Review of the Literature. Clinical Infectious Diseases 1999;29:862–8.
3) Roguin A, Gavish I, Ben Ami H, Edoute Y. Pleural empyema with Salmonella mendoza following splenic abscesses in a patient with myelodysplastic syndrome. The Israel Medical Association journal .1999 Nov;1(3):195-6.
4) Murdoch MB, Peterson LR. Nontyphoidal Salmonella Pleuropulmonary Infections. Arch Intern Med. 1991;151(1):196. doi:10.1001/archinte.1991.00400010178029.
5) Aleali SH, Castro O, Spencer RP, Finch SC. Sideroblastic Anemia with Splenic Abscess and Fatal Thromboemboli after Splenectomy. Ann Intern Med. 1975;83(5):661-663. doi:10.7326/0003-4819-83-5-661
6) Shamiss A, Thaler M, Nussinovitch N, Zissin R, Rosenthal T. Multiple Salmonella enteritidis leg abscesses in a patient with systemic lupus erythematosus. Postgrad Med J (1990) 66, 486 – 488.
7) Cistulli PA, Barnes DJ, Young GA. Salmonella empyema in a patient with lymphoma. Australian and New Zealand Journal of Medicine. 1991;21(2):246–247.
8) Akkoyunlu Y, Ceylan B, Iraz M, Elmadag NM, Aslan T. Muscle Abscess due to Salmonella Enterica. Iran Red Crescent Med J. 2013 July; 15(7):605–607. doi: 10.5812/ircmj.6852
9) Collazos J, Mayo J, Martínez E, Blanco MS. Muscle infections caused by Salmonella species: case report and review. Clin Infect Dis. 1999 Sep;29(3):673-7.
10) Toma A, Fenaux P, Dreyfus F, Cordonnier C. Infections in myelodysplastic syndromes. Haematologica 2012;97(10):1459-1470. doi:10.3324/haematol.2012.063420
11) Dayyani F, Conley AP, Strom SS, Stevenson W, Cortes JE, Borthakur G, et al. Cause of death in patients with lower-risk myelodysplastic syndrome. Cancer. 2010;116(9):2174-9.
12) Cunningham I, MacCalum SJ, Nicholls MD, Byth K, Hewson JW, Arnold B, et al. The myelodysplastic syndromes: an analysis of prognostic factors in 226 cases from a single institution. Br J Haematol. 1995;90(3):602-6.
13) Ganser A, Hoelzer D. Clinical course of myelodysplastic syndromes. Hematol Oncol Clin North Am. 1992;6(3):607-18.
14) Mufti GJ, Galton DAG. Myelodyslastic syndrome natural history and features of prognostic significance. Clin Haematol. 1986;15(4):953-69.
15) Marisavljevic’ D, Kraguljac N, Rolovic’ Z. Immunologic abnormalities in myelodysplastic syndromes: clinical features and characteristics of the lymphoid population. Med Oncol. 2006;23(3):385-91.
16) Katsuki K, Shinohara K, Kameda N, Yamada T, Takeda K, Kamei T. Two cases of myelodysplastic syndrome with extramedullary polyclonal plasma cell proliferation and autoantibody production: possible role of soluble Fas antigen for production of excessive self-reactive B cells. Intern Med. 1998;37(11):973-7.
17) Okamoto T, Okada M, Mori A, Saheki K, Takatsuka H, Wada H, et al. Correlation between immunological abnormalities and prognosis in myelodysplastic syndrome patients. Int J Hematol. 1997;66(3):345-51.
18) Shioi Y, Tamura H, Yokose N, Satoh C, Dan K, Ogata K. Increased apoptosis of circulating T cells in myelodysplastic syndromes. Leuk Res. 2007;31(12):1641-8.
19) Kiladjian J, Bourgeois E, Lobe I, Braun T, Visentin G, Bourhis J, et al. Cytolytic function and survival of natural killer cells are severely altered in myelodysplastic syndromes. Leukemia. 2006;20(3):463-70.
20) Epling-Burnette P, Bai F, Painter J, Rollison D, Salih H, Krusch M, et al. Reduced natural killer (NK) function associated with high-risk myelodysplastic syndrome (MDS) and reduced expression of activating NK receptors. Blood. 2007;109(11):4816-24.
21) Lee JH, Lee KH, Lee JH, Kim DY, Kim SH, Lim SN, et al. Decreased incidence of febrile episodes with antibiotic prophylaxis in the treatment of decitabine for myelodysplastic syndrome. Leuk Res. 2011;35(4):499-503.
22) Mele L, Ricci P, Nosari A, Tonso A, Fianci L, Cudillo L, et al. Invasive fungal infection in patients with myelodysplastic syndrome: a report of twelve cases. Leuk Lymphoma. 2002;43(8):1613-7.
23) Acharya D, Trakulsomboon S, Madhup SK, Korbsrisate S. Antibiotic susceptibility pattern and the indicator of decreased ciprofloxacin susceptibility of Salmonella enterica serovar Typhi isolated from Dhulikhel Hospital, Nepal. Jpn J Infect Dis. 2012;65(3):264-7.
24) Chau TT, Campbell JI, Galindo CM, et al. Antimicrobial drug resistance ofSalmonella enterica serovar Typhi in Asia and molecular mechanism of reduced susceptibility to the fluoroquinolones. Antimicrob. Agents Chemother.2007;51:4315–4323.
25) Khanal B, Sharm SK, Bhattacharya SK, et al. Antimicrobial susceptibility patterns of Salmonella enterica serotype Typhi in Eastern Nepal. J. Health Popul. Nutr. 2007;25:82–87.
26) Madhulika U, Harish BN, Parija SC. Current pattern in antimicrobial susceptibility of Salmonella Typhi isolates in Pondicherry. Indian J. Med. Res. 2004;120:111–114.
27) Asna SM, Haq JA, Rahman MM. Nalidixic acid-resistant Salmonella enterica serovar Typhi with decreased susceptibility to ciprofloxacin caused treatment failure: a report from Bangladesh. Jpn. J. Infect. Dis. 2003;56:32–33.
28) Antimicrobial Resistance Surveillance Reference Laboratory. Antimicrobial Resistance Surveillance Program 2012 Data Summary Report. Manila: Department of Health, Research Institute for Tropical Medicine, ARSP, 2012.
Published
21-Dec-2015
How to Cite
Tabula, J. (2015). Salmonella Typhi Leg Abscess in a Patient with Myelodysplastic Syndrome. Res Medica, 23(1), 58-62. https://doi.org/10.2218/resmedica.v23i1.1215
Section
Case Report
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