Fatal Salmonella Typhi Necrotising Fasciitis following Intra-articular Steroid Injection

Abstract

Intra-articular steroids administration in the absence of aseptic precautions can have disastrous consequences. Immunocompromised patients are at an increased risk of developing infections following such procedures. Salmonella has been infrequently reported as a causative organism for necrotising fasciitis. Gram negative endotoxemia with disseminated intravascular coagulation resulted in fatality in this patient. The case study is being presented to emphasise the need for aseptic precautions and sterile techniques while administering intra-articular steroids, to have a low threshold towards treating early joint infections expeditiously, and to consider possibility of a gram negative organism as a cause of septicaemia and necrotising fasciitis especially in debilitated patients.

Necrotizing Fasciitis: Expect the unexpected

“…Mono-microbial necrotizing fasciitis due to Salmonella serovars is extremely rare [ 12 , 13 ]; although it has been reported both with and without a prodromal diarrheal illness. There have been no previous reports of human NF due to Salmonella newport [ 14 , 11 ].…”

Dry Gangrene in Children with Typhoid Intestinal Perforation: A Report of Two Cases

“…In Salmonella septicemia, the complex lipopolysaccharides in the outer membrane of the bacteria may act as endotoxin which may result in the immune-mediated activation of the fibrinolytic and coagulation pathways and the release of vasoactive factors [ 5 , 8 ]. Also, DIC has been proposed as the common pathway in SPG pathogenesis [ 10 , 11 ].…”