Salmonella group D septic arthritis and necrotizing fasciitis in a patientwith rheumatoid arthritis and diabetes mellitus

Necrotizing fasciitis is an uncommon manifestation of Salmonella infection. We report a case of Salmonella group D septic arthritis complicated with n ecrotizing fasciitis in a 51-year-old man who had noninsulin dependent diab etes mellitus and rheumatoid arthritis. He presented with fever and severe right hip pain complicated with septic shock and disseminated intravascular coagulation. Crepitation was noticed upon physical examination, and plain films showed numerous air bubbles in the soft tissue around the hip joint. Prompt antibiotic therapy and surgical management were performed with a suc cessful response. The causative organism was Salmonella group D. Antibiotic was given in the total course of 3 months, and there was no relapse of sal monellosis after 2 years follow up. The differential diagnosis of causes of nonclostridial crepitant soft tissu e and muscle infections must include Salmonella, especially in patients who have underlying diseases or are taking immunosuppressive drugs. Prompt man agement is needed to reduce mortality and morbidity. Long-term suppressive therapy may be needed to prevent relapse.