Chest wall abscess and costochondritis due to Salmonella enterica serotype Choleraesuis: a case report

BACKGROUND

Salmonella enterica serotype Choleraesuis infections usually cause self-limited gastrointestinal diseases. Extra-abdominal infections are often secondary to bacteremia in immunocompromised individuals and are relatively rare in immunocompetent hosts.

CASE PRESENTATION

A 65-year-old Caucasian female initially presented to the thoracic surgery clinic due to a poorly healing wound on her chest. Her condition started after a mechanical fall hitting her chest with interval development of a tender lump that later spontaneously drained. A chest computed tomography scan with intravenous contrast demonstrated an abnormal infiltration with small foci of fluid and air consistent with a small abscess anterior to the left seventh costal cartilage. Aspirate culture of the abscess grew S. enterica serotype Choleraesuis susceptible to ampicillin and trimethoprim/sulfamethoxazole. The patient had no prior history of signs or symptoms of gastrointestinal infection. Blood cultures were negative. With a background of penicillin allergy, she was treated with trimethoprim/sulfamethoxazole, and later with ceftriaxone due to persistent drainage of the wound. Follow-up chest computed tomography scan with intravenous (IV) contrast showed continued abnormal findings previously seen in the computed tomography scan with the appearance of a sinus tract. The patient subsequently underwent surgical debridement and partial resection of the left seventh costochondral cartilage and excision of the fistula. She had an uneventful recovery and complete resolution of her condition.

CONCLUSION

We report a rare case of chest wall abscess with associated costochondritis due to S. enterica serotype Choleraesuis in a patient with no evidence of immunodeficiency nor history of bacteremia. Extraintestinal infections due to Salmonella without documented bacteremia have been previously reported in the literature. History of local trauma to the affected area might contribute to the seeding of infection. Diagnosis is often accomplished by clinical evaluation and culture of the affected area. Treatment often involves targeted antibiotic therapy but may require surgical intervention to achieve source control and cure.