Non-thyphoidal salmonellosis in patients with systemic lupus erythematosus. A study of fifty patients and a review of the literature

The objective of this study was to characterize the clinical profile of lup us patients with non-typhoidal salmonellosis. A retrospective review of the clinical charts of lupus patients diagnosed with bacteriologically proven non-typhoidal salmonellosis over the last 20y was undertaken, paying specia l attention to risk factors, clinical presentation and treatment outcome. M ost episodes were bacteraemic without a localizing focus; and some patients were afebrile. They usually occurred in patients prone to opportunistic in fections, and at times of increased immunosuppression given for lupus flare s (especially nephritis). However, salmonellosis also occurred in some pati ents presenting with lupus. The C-reactive protein level was found to be si gnificantly higher during the infective episodes compared to episodes of no n-infective febrile lupus flare. All isolates were sensitive to the usual f irst-line antibiotics and eminently treatable with 3 weeks of appropriate a ntibiotics without recurrence/persistence or significant morbidity/mortalit y, the exceptions being spinal osteomyelitis and septic arthritis involving deformed joints requiring surgical debridement and prolonged antibiotic th erapy for eradication. Mortality occurred in the setting of septic shock fr om mixed-microbial sepsis and major organ failure from active lupus. There is a high association of non-epidemic, non-typhoidal salmonellosis with SLE , especially in patients with active disease on intensified immunosuppressi on. The C-reactive protein value may be helpful in distinguishing between f ever from a pure lupus flare and one complicated by infection.