Salmonella enteritis Spondylitis with Brucella melitensis Infection: A Rare Case of Mixed Infections of Spine

Abstract

Background: As a widespread back condition in orthopedics, spondylitis is rarely caused by Salmonella. Here, we report a rare case of spondylitis caused by Salmonella enteritis associated with Brucella melitensis. Case Presentation: Salmonella septicemia was initially diagnosed in a 27-year-old woman with high fever and low back pain, but her symptoms did not improve after 3 days of antibiotic treatment. The patient was then referred to our hospital’s Department of Infectious Diseases. This patient had mild anemia. There were no positive results for tuberculosis antibody and Rose Bengal plate agglutination (RBPT). When the patient’s symptoms did not improve after diagnostic anti-tuberculosis treatment, he was transferred to our Orthopaedics department for lumbar posterior lesion removal, decompression, internal fixation, cage implantation, and bone grafting fusion under general anesthesia. Following the operation, a postoperative specimen culture and a real-time polymerase chain reaction (real-time-PCR) indicated Salmonella enteritis with Brucella melitensis (B. melitensis) infection. The symptoms improved and inflammatory markers returned to normal after 2 weeks of treatment with levofloxacin, rifampicin, and doxycycline. Conclusion: Anaemic patients with immunocompromised conditions should be given special attention in the diagnosis of Salmonella spondylitis. Surgery should be considered if antibiotic therapy fails to identify the pathogen that is infecting the patient with infectious spondylitis.