Intractable Salmonella epididymitis in a patient with Systemic Lupus Erythematosus– a case report and literature review
Tung-Ping Chang1, Andy C. Huang1, Thomas Y. Hsueh1,2, Yi-Jiun Hsiao1, Yu-Wei Lai1,2, Allen W. Chiu1,2
1. Department of Urology, Taipei City Hospital Ren Ai branch, Taipei, Taiwan
2. Department of Urology, National Yang-Ming University, Taipei, Taiwan
Salmonella epididymitis is rare and may be life-threatening in immunocompromised patients. Herein we reported a case of salmonellosis involving the genitourinary tract, including epididymis with refractory septic shock in a man with systemic lupus erythematosus(SLE).
A 55-year-old male with a history of systemic lupus erythematosus and seizure under prednisolone and valproate control presented to the emergency department with a 3-day history of painful and swollen left scrotum and fever. Abdominal computed tomography(CT) confirmed left ureteral stone with hydronephrosis and inflammatory process affecting the left epididymis without abscess formation. The patient received operation and urine drainage from bladder by Foley catheter after fever subsided. Urine culture isolated Salmonella spices which were susceptible to Cefepime, Imipenem, Meropenem and Trimethoprim/Sulfameth, so Meropenem was prescribed. Refractory septic shock and fever episodes has lasted for 2 weeks, so antibiotics was changed to Ertapenem and Gentamicin.The inotropic agents was gradully tapered off and the patient was discharged after completing an entire course of antibiotics.
Extra-intestinal Salmonella infections are rare clinical condition and epididymitis with refractory septic shock is intractable. Glucocorticoids in patients with systemic lupus erythematosus may be a risk factor. Treatment was empirically started and once the culture and sensitivity reports were available, antimicrobial therapy
was modified accordingly. Parenteral therapy
is recommended for at least 7 days followed by oral antibiotics for at least 4 weeks.