Volume 9 • Issue 1 • 10001204 J Clin Case Rep, an open access journal ISSN: 2165-7920 Kolarov et al., J Clin Case Rep 2019, 9:1 DOI: 10.4172/2165-7920.10001204 Open Access Case Report Journal of Clinical Case Reports J o u r n a l o f C li n i c a l C a s e R e p o r t s ISSN: 2165-7920 Focal Myositis in Salmonella paratyphi B Infection: A Case Report Kolarov C*, Hemmer CJ, Geerdes-Fenge H, Loebermann M and Reisinger EC Department of Tropical Medicine, Infectious Diseases and Nephrology, Medical Center 4, The University of Rostock, Rostock, Germany Abstract Background: We report a case of focal myositis caused by an infection with Salmonella paratyphi B in an 18-year-old immuno-competent woman. Methods: Case report and review of the literature on Salmonella causing (pyo)-myositis. Results: An 18-year-old woman developed a focal myositis of the iliopsoas, gluteus medius and piriformis muscles on the right side occurring 2 days after onset of fever caused by Salmonella paratyphi B infection. Other reasons for focal myositis were excluded. Conclusion: This is the frst reported case of focal myositis being caused by an infection with Salmonella paratyphi B in a previously healthy patient. *Corresponding author: Kolarov C, Department of Tropical Medicine, Infectious Diseases and Nephrology, Medical Center 4, The University of Rostock, Rostock, Germany, Tel: + 49(0)381/494-7511; E-mail: claudia.dreyer@med.uni-rostock.de Received January 14, 2019; Accepted January 21, 2019; Published January 25, 2019 Citation: Kolarov C, Hemmer CJ, Geerdes-Fenge H, Loebermann M, Reisinger EC (2019) Focal Myositis in Salmonella paratyphi B Infection: A Case Report. J Clin Case Rep 9: 1204. doi: 10.4172/2165-7920.10001204 Copyright: © 2019 Kolarov C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Salmonella paratyphi B; Focal salmonellosis; Myositis; Bacterial myositis; Salmonella-associated myositis/ pyomyositis Introduction Myositis presents with pain, tenderness, swelling, and weakness of a voluntary muscle and is caused by infammation brought about by infection, autoimmune conditions, genetic disorders, the adverse efects of medication, electrolyte disturbances, or diseases of the endocrine system [1]. A wide variety of pathogens, including bacteria, fungi, parasites and viruses can cause myositis, though pyomyositis usually results from the hematogenous spread of gram-positive bacteria such as Staphylococcus aureus or Streptococcus pyogenes [2]. Gram-negative organisms e.g. Salmonella spp. are seen predominantly among patients with diverse underlying conditions [3]. A Medline search using the terms “salmonella”/”salmonellosis”/ ”typhoid” in combination with “myositis”/”pyomyositis” yielded fve reports of Salmonella typhi-associated pyomyositis [3-7], more than 30 cases of pyomyositis caused by “non-typhoid Salmonella spp.” [3,8- 10]. In addition, one report was found of “crepitant myonecrosis” complicating Salmonella paratyphi B infection in a 72-year-old diabetic with severe atherosclerosis [11]. To our knowledge, this is the frst report of Salmonella paratyphi-associated focal myositis in a previously healthy patient. Case Report Two days afer returning from Peru an 18-year-old woman presented in our Emergency Room with fever. Te patient reported a one-week episode of watery, greenish diarrhea in Peru, orally treated with ciprofoxacin, cotrimoxazole and azithromycin. She could not remember the dose and duration of the antibiotic therapy. 18 days afer this diarrheal episode, while still in Peru, she sufered from continuous fever of 40°C lasting for six days with a maximum of 41°C on the sixth day. 2 days afer the beginning of the fever attack, she experienced intense back pain with dissemination into the right buttock and the dorsal thigh. Her medical history consisted of surgical correction of fat feet (7 years ago), surgical correction of a leg length diference on the right side (5 years ago), and tonsillectomy as a child. She had no history of muscular injections. Physical examination revealed a patient of leptosome build (170 cm, 55 kg, BMI 18.6 kg/m ² ) in reduced general condition with pain-restricted movement of the right leg, resting pain and tenderness to palpation of the lumbar part of the vertebral column and the right gluteal muscles, tenderness in the right lower abdomen at Mc Burney´s point, and a positive Lasègue’s sign. Initial laboratory fndings revealed thrombocytopenia of 111 × 10 -9 per liter (normal 150 to 450), hyponatremia 129 mmol/l (normal 136 to 144), hypokalemia 3.2 mmol/l (normal 3.6 to 5.1), increased ASAT/GOT 136 U/l (normal <30) and ALAT/GPT 73.7 U/l (normal <30), gamma-GT 234 U/l (normal <40), AP 229 U/l (normal 47 to 119), LDH 438 U/l (normal <240), C-reactive protein 173 mg/l (normal <5), leukocytosis of 10.3 × 10 -9 per liter (normal 4 to 9), creatine kinase of 1221 U/l (normal <170), Myoglobin of 113 ng/ml (normal 25 to 58) and CK-MB 31.5 U/l (normal <24). Diferential blood count revealed increased neutrophils with 9.25 × 10 -9 per liter (normal 2 to 8), lowered lymphocytes with 0.67 × 10 -9 per liter (normal 1 to 3.2) and eosinophils with 0.01 × 10 -9 per liter (normal <0.7). In two paired aerobic/anaerobic blood cultures, Salmonella paratyphi B, susceptible to cefotaxime, meropenem, cotrimoxazole, azithromycin and chloramphenicol, intermediately susceptible to ampicillin, and resistant to ciprofoxacin was detected. Repeated urine and stool cultures did not grow Salmonella spp. or other pathogens. Myositis autoantibody and anti-nuclear antibody (ANA) serum titers were normal, anti- cytoplasmatic antibodies showed a titer of 1:100 (normal <1:100). Serum levels of complement factors C3 and C4 were elevated at 1.68 g/L (normal 0.79 to 1.52) and 0.53 g/L (normal 0.1 to 0.4) respectively. Malaria was excluded in blood smears, Leishmania, Dengue, Chikungunya, Zika and HIV infections were excluded serologically. Electrocardiography revealed a sinus tachycardia with 117 bpm with no other pathological fndings. Te admission chest x-ray revealed no infltrates or other abnormalities. Ultrasound imaging