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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1070-1071

Salmonella Osteomyelitis of Skull Bone: A Rare Case


1 Department of Neurosurgery, P D Hinduja Hospital, Mumbai, Maharashtra, India
2 Department of Infectious Diseases, P D Hinduja Hospital, Mumbai, Maharashtra, India

Date of Submission04-Oct-2018
Date of Decision22-Jul-2018
Date of Acceptance12-Nov-2019
Date of Web Publication2-Sep-2021

Correspondence Address:
Anshu C Warade
C/o Sandhya, Department of Neurosurgery, 2nd Floor, Wing No 1, Hinduja Clinic, Hinduja Hospital, Veer Sawarkar Marg, Mahim, Mumbai - 400 016, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325382

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How to cite this article:
Warade AC, Agrawal US, Sunawala AJ, Desai K. Salmonella Osteomyelitis of Skull Bone: A Rare Case. Neurol India 2021;69:1070-1

How to cite this URL:
Warade AC, Agrawal US, Sunawala AJ, Desai K. Salmonella Osteomyelitis of Skull Bone: A Rare Case. Neurol India [serial online] 2021 [cited 2021 Nov 28];69:1070-1. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1070/325382




Sir,

A 31-year-old male patient presented with complaints of headaches for last two months. Magnetic resonance imaging (MRI) scan revealed a large left frontal meningioma [Figure 1]a and [Figure 1]b. He had history of gastroenteritis 2 weeks prior to the admission. Craniotomy and excision of meningioma were performed [Figure 2] and histopathology revealed atypical meningioma.
Figure 1: Postcontrast MRI scan showing homogenously enhancing parasagittal frontal meningioma

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Figure 2: Immediate postoperative CT scan showing normal craniotomised bone

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On the 10th postoperative day, he had pus discharge from the operative site. The pus culture revealed  Salmonella More Details paratyphi A. He received multiple antibiotics such as amoxicillin-clavulanate, azithromycin, and trimethoprim-sulfamethoxazole based on antibiotic sensitivity report for a period of six weeks. The discharge from the sinus tract, however, persisted.

A follow-up MRI scan at three months revealed complete excision of the tumor. A computerized tomography (CT) scan demonstrated osteomyelitis of frontal craniotomy flap [Figure 3]a and [Figure 3]b. He was reoperated on; infected bone flap and underlying dura were excised and culture revealed S. paratyphi A. The patient received oral azithromycin (500 mg) twice a day for six weeks. At 2-month follow-up, the wound had healed and there was no discharge from the operated site.
Figure 3: (a). CT scan (Postop 3 months) showing osteomyelitis of left frontal craniotomised bone. (b). MRI scan (Postop 3 months) showing underlying dural enhancement

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Osteomyelitis of the skull is rare.[1] The most common organism causing osteomyelitis is Staphylococcus aureus Scientific Name Search  following local trauma or craniotomy and Pseudomonas aeruginosa in diabetics and immunosuppressed patients.[2] Osteomyelitis caused by organism Salmonella is a rare occurrence with reported incidence of less than 1%.[3],[4],[5] Usually, it affects long bones or body of vertebra, but other bones can also get affected by Salmonella-related infection. Onset is usually during the convalescent stage of the disease that is 4th week onwards. Predisposing factors for Salmonella osteomyelitis are sickle cell hemoglobinopathy, systemic lupus erythematosus (SLE), immunosuppression, and impaired cell-mediated immune response found in AIDS.[2] The highly vascular tumor-like meningioma may have also contributed to this infection.

Following Salmonella infection, there occurs bacteremia and these bacteria lodge themselves in the long bones and diploe of the skull. Predisposing factors such as craniotomy or local trauma trigger the dormant bacilli in the diploe of the skull and cause acute osteitis followed by osteomyelitis.[1] The management of this condition involves proper clinical history and diagnosis, prolonged antibiotic therapy, and surgery.[2]

Only 14 cases of Salmonella skull osteomyelitis have been reported of which most of them were caused by Salmonella typhi. Only three cases of S. paratyphi infection have been reported, S. paratyphi B (2 cases) and S. paratyphi A (1 case) [Table 1].[1],[2],[3],[4],[5] We report the 2nd case of S. paratyphi A skull osteomyelitis following a craniotomy for frontal meningioma tumor excision.
Table 1: Clinical details of patients with Salmonella Paratyphi (A & B) skull osteomyelitis

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Peyser E, Madorsky M. Paratyphoid B osteomyelitis of frontal bone. Br Med J 1952;2:320-1.  Back to cited text no. 1
    
2.
Kamarulzaman A, Briggs RJ, Fabinyi G, Richards MJ. Skull osteomyelitis due to Salmonella species: Two case reports and review. Clin Infect Dis 1996:22:638-41.  Back to cited text no. 2
    
3.
Suzuki Y, Sugiyama Y, Ishii R, Sato I. Brain abscess caused by Salmonella typhi. J Neurosurg 1976;45:709-11.  Back to cited text no. 3
    
4.
Bhooshan P, Shivaprakasha S, Dinesh KR, Kiran M, Karim PMS. Chronic subdural empyema and cranial vault osteomyelitis due to Salmonella paratyphi A. Indian J Med Microbiol 2010;28:60-2.  Back to cited text no. 4
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5.
Thakur K, Singh DV, Goel A. Cranial vault Salmonella osteomyelitis leading to extradural abscess—A case report. Indian J Med Microbiol 2002;20:219-20.  Back to cited text no. 5
[PUBMED]  [Full text]  


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