Salmonella septic arthritis complicating rheumatoid arthritis in patient with total knee replacement

Objective and Importance: Salmonella septic arthritis (SSA) in any age group is a relatively ra re disease. The prime objective of th is communication is to report a relatively uncommon presentation of SSA in a prosthetic knee joint of a patient with rheumatoid arthritis. Clinical Presentation: We report a 51-year-old lady with rheumatoid arthritis and total knee replacement who, while on methotrexate and azathioprine, developed Salmonella enteritidis bacteraemia complicated by septic monoarthritis of the left prosthetic knee. The same organism, using pulsed-field gel electrophoresis typing method, was isolated from the blood, joint aspirate and stool. Intervention: She was aggressively treated with antibiotics by giving the maximum dose of ceftriaxone, 2 g intravenously every 8 h for 4 weeks. In addition, close drainage with syringe and needle was also done on a few occasions. She responded well to this regimen. Follow-up for approximately 1 year at the clinic has been uneventful. Conclusion: SSA in a patient with a history of diarrhoea and a recent visit to the Indian subcontinent should be investigated for salmonella infection. Adequate antibiotic therapy, with repeated close drainage of the joint, is recommended for SSA in a prosthetic joint.