Salmonella vertebral osteomyelitis with bilateral psoas myositis in a patient with newly diagnosed diabetes: a case report and literature review

Abstract

Background

Salmonella vertebral osteomyelitis (SVO) is a rare complication, occurring in approximately 0.8% of Salmonella infections. Bilateral psoas muscle involvement has not been previously documented.

Case presentation

We report the first documented case of SVO with bilateral psoas myositis in a 56-year-old Vietnamese woman with newly diagnosed type 2 diabetes mellitus (HbA1c 9.2%). The patient presented with high fever (39 °C), visual analogue scale (8/10), and absence of gastrointestinal symptoms. Multiple antibiotic-susceptible Salmonella spp. were isolated from her blood culture. Magnetic resonance imaging demonstrated L3 vertebral osteomyelitis with bilateral psoas muscle high signal, indicating active myositis. Initial treatment with ceftriaxone and ciprofloxacin was ineffective, necessitating escalation to meropenem combined with ciprofloxacin, which resulted in clinical improvement after 4 days.

Conclusion

In summary, this exceptional case represents the first reported SVO with bilateral psoas myositis, emphasizing the importance of advanced imaging and aggressive antibiotic therapy in diabetic patients presenting with fever and back pain, even without gastrointestinal symptoms.