Extraintestinal Salmonellosis Unmasked in a Parotid Mass

Authors

Kahmalia-Kalee Sada, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Presentation

Publication Date

4-28-2023

Keywords

salmonella, salmonella infections, parotid gland, internal medicine

Disciplines

Bacterial Infections and Mycoses | Internal Medicine

Abstract

Salmonella infection can cause a wide range of presentations, predominantly gastrointestinal but occasionally with cardiovascular or other extraintestinal manifestations. The diagnosis of extraintestinal salmonellosis requires a high degree of clinical suspicion and should be considered in patients with deep-seated abscesses. [1]. Typically, these types of infections, are extremely rare, and when revealed are typically seen in the immunocompromised patient with chronic illness, HIV, or Hepatitis. While the incidence of nontyphoid salmonellosis is estimated at over 2 million cases annually, extraintestinal manifestations account for less than 1% of cases. Studies have revealed that individuals with diabetes have risk for salmonellosis due to gastric impairments, this case serves as an example. A 71-year-old male with past medical history of diabetes type 2, hypertension, presents to the ED for left facial swelling. The left infraauricular pain traveled to his upper jaw and has been ongoing for the past 3 days. He followed up with his primary care physician, received oral antibiotics and an injection of antibiotics along with some pain medications and has been taking those for 2 days without relief. He received Rocephin and vancomycin upon arrival. His laboratory values were within normal limits except a White Blood count which was mildly elevated. CT scan was completed which revealed a large enhancing mass with a fluid collection in the center. A needle aspiration biopsy of the large mass was read by the pathologist and found to have inflammatory cells and polymicrobial flora was growing from the cultures that were sent as a result of that. Patient underwent and incision and drainage twice for excessive fluid collection and swelling with ENT. Cultures grew Extended spectrum beta lactamases Salmonella. With collective findings of the parotitis growing extraintestinal salmonellosis, he was placed on Levaquin for two weeks for treatment. From what we know of the literature, this patient is a chronic Salmonella carrier state, which can lead to progressing extra intestinal salmonellosis. This case illustrates a rare entity of extraintestinal salmonellosis which can be seen in immunocompromised, even less common in immunocompetent individuals. A highly unusual diagnosis, that was seen in this patient. He was likely a chronic Salmonella carrier state, which lead to the extraintestinal findings of the parotid mass. Recognition of the chronic carrier state of salmonella is important to keep Salmonella as a plausible organism when dealing with infectious cases, and for appropriate therapy.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Sada, Kahmalia-Kalee, "Extraintestinal Salmonellosis Unmasked in a Parotid Mass" (2023). North Texas GME Research Forum 2023. 37.
https://scholarlycommons.hcahealthcare.com/northtexas2023/37