SHM Converge Scientific Abstract ePoster Gallery-When Salmonella Shows Its True Colors: A Rare Case of Skin Rash

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This case report describes a rare extra-intestinal Salmonella infection presenting as cellulitis in a 24-year-old Hispanic man with systemic lupus erythematosus (SLE) complicated by class IV/V lupus nephritis and on immunosuppressive therapy. Because SLE and its treatment increase susceptibility to infection, the patient was at elevated risk for unusual or severe infectious presentations.<br /><br />He presented with erythema, swelling, and pain in the lower abdomen, left leg, and right thigh, along with fever, dyspnea, and diarrhea. On examination, he appeared ill and had tachycardia, tachypnea, bilateral leg edema, and a tender erythematous violaceous rash. Initial evaluation showed leukocytosis, lactic acidosis, acute kidney injury, and hyperkalemia. CT imaging revealed anasarca and a small left pleural effusion, while ultrasound of the lower extremities showed no deep vein thrombosis but did show soft tissue changes consistent with cellulitis and myositis.<br /><br />He was initially treated with IV meropenem and clindamycin, and mycophenolate was held because of diarrhea. Blood and stool cultures later grew Salmonella, prompting a switch from meropenem to IV ceftriaxone while clindamycin was continued. The patient improved within 48 hours, was transferred out of the ICU on hospital day 4, and was discharged on day 14 after completing IV antibiotics. At discharge, his immunosuppression was adjusted with reduced mycophenolate and prednisone, and nephrology follow-up was arranged.<br /><br />The report emphasizes that although Salmonella usually causes gastrointestinal illness, it can rarely cause cellulitis and other invasive infections in immunocompromised patients. Early recognition, culture-directed antibiotic therapy, and careful management of immunosuppression are essential to prevent progression to sepsis.

Asset Subtitle

Rao M. Afzal

Meta Tag

Author List Ehab Faheid, Khulood Shahid, Rao M. Afzal, Sofiya Rehman

Category Clinical Vignettes

Concept Systemic Lupus Erythematosus

Concept Infection Susceptibility

Concept Cellulitis

Concept Culture

Concept Antimicrobial Therapy

Distinguished Non-Finalist

Presenter Organization Hunt Regional Medical Center/ Arkansas College of Osteopathic Medicine

Presenting Author Rao M. Afzal

Track Adult

Keywords

Salmonella infection

cellulitis

systemic lupus erythematosus

immunosuppressive therapy

lupus nephritis

extra-intestinal infection

ceftriaxone

blood culture

myositis

sepsis

Systemic Lupus Erythematosus

Infection Susceptibility

Cellulitis

Culture

Antimicrobial Therapy