Brodie's Abscess Caused bySalmonella enteriticaserovar Senftenberg in a Healthy Child

Abstract

A 13-year-old girl presented in a local clinic with intermittent left ankle pain for 3 months without any history of trauma. She often had discomfort in walking but with no altered sensation or swelling. The patient was transferred to our hospital for the persistent pain in her left ankle. Fever and other constitutional symptoms were absent at presentation. There was no family history of specific illness and no evidence of any underlying diseases. A physical examination revealed swelling and mild tenderness of her left ankle. She had no systolic murmur or other specific findings. She undertook simple radiography and magnetic resonance imaging (MRI). Preoperatively, blood examination revealed a leukocyte count of 6.0×10/L (reference range, 4.0∼10.0×10/L) with neutrophils in 54%, a hemoglobin level of 12.5 g/dL (reference range, 12∼14 g/dL) and a platelet count of 398×10/L (reference range, 140∼ 450×10/L). C-reactive protein level was at 0.08 mg/dL (reference range, 0∼0.5 mg/dL), and an erythrocyte sedimentation rate at 6 mm/hr (reference range, <25 mm/hr). A preoperative simple radiography of lower extremity showed well-defined lytic lesion in the metadiaphyseal region of the left distal tibia (Fig. 1). MRI of the left ankle using T1-weighted and T2-weighted MRI showed a well-defined and bilobed intramedullary cystic lesion in metadiaphysis of left distal tibia about 18 mm in diameter and 40 mm in length. This lesion revealed uniform rim enhancement, marrow edema and thin periosteal reaction, and no definite cortical disruption nor soft tissue mass was noted (Fig. 2). A percutaneous needle biopsy of the lesion showed an intracortical lytic lesion with a tiny, hyperdense focus at its center and revealed chronic inflammatory tissue reaction. She underwent a surgery for the debridement of Brodie’s abscess. Aspirates of abscess during the operation were cultured sequentially and yielded Salmonealla spp., group E by performing Gram stain, Salmonella/Shigella and triple sugar iron agar findings, and antisera grouping with no other pathogenic colonies. S. enterica serovar Senftenberg was finally identified by conventional and molecular identification methods at the Institute of Health and Environment in Daegu. Antimicrobial susceptibility test was done by VITEK system (bioMerieux VITEK, Hazelwood, MO, USA) and revealed susceptible to ampicillin, cefotaxime and ciprofloxacin except trimethoprim-sulfamethoxazole. The infection was successfully treated with operational curettage and intravenous cefotaxime. After 2 weeks of the treatment, cefotaxime was changed to per oral and she returned to outpatient clinic.