The genus Salmonella
consists of a large heterogeneous group of gram negative bacilli that affect humans and animals. They are enteroinvasive and enteropathogenic organisms. Human beings are infected mainly by ingestion of food or water resulting in 4 types of clinical syndromes: enteric fever, septicemia with or without suppurative lesions, gastroenteritis, and carrier state [1
Salmonellosis is endemic in developing countries. Though the most common manifestation of Salmonella typhi
is fever, infection can spread through blood stream and present as focal lesions in any organ with or without suppuration. Localised infections at metastatic sites usually occurs in patients with preexisting diseases, such as hemoglobinopathies especially sickle cell disease [3
]. Osteoarticular infections occur commonly in the immunosuppressed [5
]. In one study 36% had preexisting osteoarticular disease [6
]. A common predisposing articular factor for Salmonella septic arthritis is avascular necrosis and the hip joint is the most frequently involved site [7
Organisms which are commonly associated with septic arthritis include Staphylococcus aureus, Haemophilus influenzae
type B, and Streptococci
arthritis is infrequent and accounts for only 1% of all cases. It usually follows gastroenteritis and is caused most often by nontyphoidal Salmonella
. Septic arthritis is an extremely rare complication of typhoidal Salmonella
]. This case was unique because, the Widal test was negative, the patient history did not reveal any significant fever in the preceding months, and the fecal culture to investigate carrier state or subclinical infection was noncontributory.
Early diagnosis, surgical intervention and administration of appropriate systemic antibiotics play a pivotal role in successful management. Chronic immunosuppression due to prolonged steroid therapy leads to depressed humoral immune response and this leads to insignificant widal titers [8
]. Although infections can predispose to avascular necrosis [9
], this patient having been on long term steroid therapy for a systemic collagen vascular disease, Salmonella typhi
could have played a secondary contributory role.