Purulent  pleurisy  caused  by  Salmonella choleraesuis : A case report

Introduction: Salmonellosis typically presents as typhoid fever or gastroenteritis, with complications being relatively rare. Pleural complications, in particular, are exceptionally uncommon. We report a rare case of purulent pleurisy caused by Salmonella choleraesuis ssp. arizonae. Case report: A 50-year-old woman, with a history of breast cancer treated with chemotherapy, radiotherapy, and ongoing hemodialysis for chronic renal insufficiency, was admitted to the medical-surgical emergency department due to hemodynamic instability. On clinical examination, she presented with acute chest pain, dyspnea, hypotension, bradycardia, and a fever of 39°C. Thoracic CT angiography excluded proximal pulmonary embolism but revealed a large pleural effusion associated with adjacent passive atelectasis. A pleural puncture allowed drainage of cloudy fluid, which was sent for bacteriological and biochemical analysis. Blood tests showed leukocytosis (12,000/mm³), normochromic normocytic anemia, and thrombocytopenia (27,000/mm³), with elevated CRP (236.4 mg/L) and procalcitonin (29.02 ng/L). Microscopic examination of the pleural fluid revealed leukocytosis (64,000/ mm³), predominantly polymorphonuclear cells (87%), and Gram-negative bacilli. Biochemical analysis indicated an exudate, with total proteins at 36 g/L. The Api20E gallery (Bio-Mérieux) allowed the identification of Salmonella choleraesuis ssp. arizonae (99.7%). Antibiotic susceptibility testing was performed using the diffusion method on Mueller-Hinton agar and interpreted according to the 2024 EUCAST guidelines

Although pleural complications due to Salmonella remain exceptionally rare, this case highlights the importance of a thorough diagnostic and therapeutic approach to salmonellosis to improve clinical outcomes and reduce associated complications - Received: - Version Posted: