Abstract
Introduction An osteomyelitis may be difficult to diagnose by conventional imaging methods; nuclear medicine imaging can detect a lesion in the very early stages, highlighting the metabolic changes preceding structural ones. We present a case of Salmonella os- teomyelitis in a 26-year-old woman, involving the distal epiphysis of the right femur. Case report The involvement usually affects a single joint, but also vertebrae or any other bones can be involved; frequently, an osteomyelitis caused by Salmonella is associated with par- ticular pathological conditions like immunodepression due to corticos- teroid treatment, systemic lupus ery- thematosus, renal transplantation, sickle cell disease or pre-existing joint disease 4 . The pathology in im- munocompetent adults is usually due to the ingestion of contaminated food products 2 . The onset of such pathology in young patients, in the absence of sig- nificant anamnestic data, can hardly be recognised, although a prompt and correct diagnosis is absolutely necessary. Conventional imaging suffers from lack of specificity, especially at the ear- ly stage of the disease. Conversely, nu- clear medicine imaging can be useful for diagnosing and monitoring Salmo- nella bone lesions, giving more infor- mation than conventional imaging 5,6 .
Highlights
An osteomyelitis may be difficult to diagnose by conventional imaging methods; nuclear medicine imaging can detect a lesion in the very early stages, highlighting the metabolic changes preceding structural ones
The involvement usually affects a single joint, and vertebrae or any other bones can be involved; frequently, an osteomyelitis caused by Salmonella is associated with particular pathological conditions like immunodepression due to corticosteroid treatment, systemic lupus erythematosus, renal transplantation, sickle cell disease or pre-existing joint disease[4]
The use of PET instead of labelled granulocyte scan was decided to avoid possible allergic reactions; we usually label granulocytes ‘in vivo’ by using radioactive antibodies, which are rarely responsible of allergic reactions
Summary
An osteomyelitis caused by Salmonella sp. is an extremely rare manifestation[1,2], especially in non-sickle cell patients[3], but with potentially lethal consequences on the skeletal system. The involvement usually affects a single joint, and vertebrae or any other bones can be involved; frequently, an osteomyelitis caused by Salmonella is associated with particular pathological conditions like immunodepression due to corticosteroid treatment, systemic lupus erythematosus, renal transplantation, sickle cell disease or pre-existing joint disease[4]. The pathology in immunocompetent adults is usually due to the ingestion of contaminated food products[2] The onset of such pathology in young patients, in the absence of significant anamnestic data, can hardly be recognised, a prompt and correct diagnosis is absolutely necessary. We here present a very unusual case of osteomyelitis caused by Salmonella typhi in a non-sickle cell patient, whose diagnosis could be obtained only with nuclear medicine imaging. The patient underwent an Magnetic Resonance Imaging (MRI), performed 1 week before, showing a non-specific osteolytic area located on the distal epiphysis of the right femur The use of PET instead of labelled granulocyte scan was decided to avoid possible allergic reactions; we usually label granulocytes ‘in vivo’ by using radioactive antibodies, which are rarely responsible of allergic reactions
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