Summary

This is a case of a 63-year-old Asian female patient who presented to accident and emergency with a febrile illness 3 weeks after her return from the Indian subcontinent. She was given empirical treatment with ciprofloxacin. Blood cultures grew a quinolone-resistant resistant Salmonella paratyphi A so she was re-called, admitted to hospital and treated with intravenous cefotaxime. She did not have known risk factors for invasive salmonellosis. On day 8 she complained of back pain, but since her fever was settling an MRI of the spine was not performed at that point.

On day 19 her fever relapsed so the MRI was done and showed images consistent with vertebral osteomyelitis at T7–T8 level. She completed 8 weeks of intravenous antibiotic therapy with good clinical response and normalisation of inflammatory markers, and was discharged on an 8 week course of oral azithromycin. On follow-up after 7 months, her back pain had settled and an MRI showed improvement.