Ciprofloxacin resistant osteomyelitis following typhoid fever

BMJ Case Rep. 2012 Jul 13:2012:bcr0320126107. doi: 10.1136/bcr.03.2012.6107.

Abstract

Salmonella typi is a rare cause of chronic osteomyelitis in a non-sickle cell patient. The authors report the case of a 25-year-old gentleman with a history of typhoid fever and an infected skin nodule on his left forearm 5 years prior to the diagnosis. He was referred to our orthopaedic colleagues with chronic osteomyelitis and underwent debridement of the bone for which samples grew Salmonella typhi. He was commenced on intravenous ceftriaxone 2 g once daily for 6 weeks followed by oral azithromycin 500 mg once daily for a further 6 weeks. The purpose of this case report is to consider the possible mode for antibiotic resistance. In this patient, the authors believe that partial treatment of the typhoid fever 5 years prior to diagnosis of osteomyelitis enabled antibiotic resistance to ciprofloxacin. Furthermore, the authors believe that the infected nodule was the result of direct inoculation with the Salmonella organism which then acted as a focus for further infections.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-Infective Agents / administration & dosage*
  • Azithromycin / administration & dosage*
  • Ciprofloxacin / analogs & derivatives*
  • Debridement
  • Drug Resistance, Microbial
  • Forearm / microbiology
  • Forearm / pathology*
  • Humans
  • Male
  • Osteomyelitis / diagnostic imaging
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Radiography
  • Salmonella Infections / drug therapy*
  • Salmonella Infections / microbiology
  • Salmonella typhi / isolation & purification*
  • Treatment Outcome
  • Typhoid Fever / complications
  • Typhoid Fever / drug therapy*
  • Typhoid Fever / microbiology

Substances

  • Anti-Infective Agents
  • Ciprofloxacin
  • Azithromycin