A 58‐year‐old African American woman presented with the acute onset of exquisite left thigh pain and erythema. Her medical history was significant for idiopathic thrombocytopenia purpura, autoimmune hemolytic anemia, and pernicious anemia because of chronic atrophic gastritis. The patient also endorsed long‐standing epigastric pain and an unintentional 80‐pound weight loss over the preceding 4 years. Physical examination was remarkable for fever, cachexia, and tender, blanchable erythema over her left medial thigh. Myositis of the vastus medialis and sartorius muscles was noted on computed tomography (CT) of the leg. The patient was empirically placed on vancomycin and ampicillin‐sulbactam. Blood cultures ultimately grew out Salmonella species, confirming the diagnosis of Salmonella myositis. The patient later revealed that her postprandial abdominal pain had forced her to begin consuming a liquid diet, consisting mainly of under‐cooked eggs. Her antibiotics were narrowed to intravenous ceftriaxone, with resolution of her symptoms over the next 2 weeks. Given concern for a concurrent gastric malignancy, she also underwent upper endoscopy, which showed a moderately differentiated adenocarcinoma nearly obstructing the gastric outlet. A staging CT scan was negative for metastatic disease, and the patient was scheduled for gastric resection.
Salmonellosis is a common food‐and waterborne illness in the United States that may be encountered by hospitalists, with more than 20% of the 1.4 million annual cases leading to hospitalization. Salmonella bacteria can cause a broad spectrum of disease, including gastroenteritis, enteric fever, bacteremia, local infection, and a chronic asymptomatic carrier state, although its exact manifestations are influenced to an unknown extent by sero‐type and host factors. This case of myositis most likely resulted from the ingestion of contaminated egg products. Disruption of the mucosal barrier from the patient's gastric malignancy predisposed her to bacterial translocation across the stomach wall, bacteremia, and subsequent seeding of the deep muscles of the thigh. Malnutrition and achlorhydria from pernicious anemia are also known risk factors for salmonellosis.
Awareness of the risk factors for Salmonella infection and its diverse clinical manifestations is critical to ensuring prompt recognition and treatment.
M. Anderson ‐ none; M. Learned ‐ none; J. Pell ‐ none
To cite this abstract:Anderson M, Learned M, Pell J. One Bad Egg. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 231. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/one-bad-egg/. Accessed March 28, 2020.