Jing Loong Moses Loh, Zubin J Daruwalla and Mark Chong
We report the case of a 14 year old girl admitted with a two day history of left sided thigh and buttock pain and fever. There was no preceding history of trauma. Physical examination revealed a temperature of 38.7°C, tenderness over the left sacroiliac joint, pain on manipulation of the joint and limited abduction and external rotation of the left hip. Radiographs of the sacroiliac joints were normal while an MRI pelvis showed signs consistent with a diagnosis of left sacroiliitis. Although initial blood cultures were negative, intravenous ceftriaxone and cloxacillin were commenced. Symptoms persisted with subsequent MRI showing an adjacent abscess. The CT guided aspiration of the abscess with a study of synovial fluid demonstrated the presence of Salmonella (non-typhi species). A second set of blood cultures revealed the same pathogen and confirmed sensitivity to ceftriaxone. Antibiotics were tailored to this result. She received intravenous ceftriaxone for a total of 90 days. On completion of intravenous antibiotic therapy, there was significant resolution of pain and improvement in ambulation. MRI findings were consistent with resolution of infection. Oral cefixime was continued for a total of 30 days. Her condition resolved with no recurrence of symptoms at the time of last follow up.
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