Via Research Recognition Day Program VCOM-Carolinas 2025

Case Reports

Salmonella Parotid Gland Abscess in a Patient with Sickle Cell Disease Juhi Patel, OMS-III 1 , Dr. Rehan Khan, MD 2 . 1. Edward Via College of Osteopathic Medicine, Spartanburg, SC. 2. Spartanburg Medical Center, Spartanburg, SC.

Introduction

Imaging

Discussion

References Ta bhsec reesps oi nr t adpe as ct irei bn et swai trha rsei c ckal es ec eolfl ad iSsaelams oe ,nheil gl ah-liingdhut icnegd t ph ae rdoitai dg ngol as nt idc and treatment challenges posed by atypical infectious presentations. Key points include : • a nS da l bmaocnt eerl leami ni af ebcut ti orna sr ei lny si ni cvkol lev ec et lhl ep pa taireontti sd og fl taennd .c a u s e o s t e o m y e l i t i s 3 • The case broadens understanding of Salmonella’s potential to target unexpected sites. • o cSceucro nmdoanrtyh si nofre cyteiaornssa, fpteortet hnet iianl liyt i aflrionmfe cct ihorno.n i c c a r r i e r s t a te s , c a n 4 • Initial treatment of the scalp swelling with cephalexin may have been insufficient due to lack of gram-negative coverage. 5 • trIematamgienngt. and cultures were crucial for diagnosis and guiding • u r e n T e u h v s i a s u l u a c l a a i t s n i e o f e n e c m t o i p o f n h t a s r s i e t iz a e e t s m s . et hnet s n ei ne d i mf o mr bu rnooacdo md ipf freorme ni stei adl dpiaatgi ne no tsse s wa int hd Conclusions Tp rhei ss e nc taastei o nc os n ot rf i bSuatlems o nt oe l ltah ei n fgercotwi oinnsg i kn n os iwc kl el ed g ec e lol f p taht iee ndt si v earnsde ht hi gi sh l ipgohpt su ltahtei onne. e dC of on rt i tnaui leodr e dd odciua mg neonsttai tci oa nn d at nh de r adpi secuut iscs isot nr a toe fg i es us ci nh cases can refine clinical guidelines and improve outcomes for similar patients. 1. Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet . 2010;376(9757):2018-2031. doi:10.1016/S0140-6736(10)61029 X 2. AlFawaz T, Alzumar O, AlShahrani D, Alshehri M. Severity of Salmonella infection among sickle cell diseases pediatric patients: Description of the infection pattern [published correction appears in Int J Pediatr Adolesc Med. 2020 Dec;7(4):213. doi: 10.1016/j.ijpam.2020.10.001]. Int J Pediatr Adolesc Med . 2019;6(3):115-117. doi:10.1016/j.ijpam.2019.05.001 3. Kurtz JR, Goggins JA, McLachlan JB. Salmonella infection: Interplay between the bacteria and host immune system. Immunol Lett . 2017;190:42-50. doi:10.1016/j.imlet.2017.07.006 4. Rodríguez M, Diego I, Mendoza MC. 1998. Extraintestinal Salmonellosis in a General Hospital (1991 to 1996): Relationships between Salmonella Genomic Groups and Clinical Presentations. J Clin Microbiol 36. https://doi.org/10.1128/jcm.36.11.3291 3296.1998 5. Viselner G, van der Byl G, Maira A, Merico V, Draghi F. Parotid abscess: mini-pictorial essay. J Ultrasound . 2013;16(1):11-15. Published 2013 Mar 2. doi:10.1007/s40477-013-0006-0

Salmonella, typically a cause of gastrointestinal illness, can lead to cbealcl tde irseema si ae iann di ms mp l ue nn eo cc toommpyr od mu ei steodi mp aptai ei rnetds , csl eu ac rha ansc et hoof seen wc ai pt hs usliac tkel de organisms .1 This case describes a 37-year-old male with sickle cell danisteibaisoeticws.hDoraidneavgeelorpeevdealepdarotid abscess after failing outpatient Salmonella species, an unusual pathogen p P fo a r r o r t p p i a e c r u r o la d ti r i d a ly g a n b in o s c s i i e m s s s m o e f u s . n p H o a i c r s o o l m t a id c p k r a o o b m f s a c is e s e s p d s l e e p s e a n r t e i l e i q k n u e t i l s y r . e i A s n l c t i r m h e o a a u g s g e in h d g s S u a a s l n m c d e o p c n t u i e b l l t l i u a li r t i e y s , . orescteoogmniyzeelditis,aasnd abacwteerlel-mdoiacuimn esnictkedle ceclaludseiseaosef , thgearsetroisenltimeriitteisd, documentation regarding its role in soft tissue infections. 2 This case fills a gap by describing a rare presentation of Salmonella in the parotid gland in a sickle cell patient, further expanding the spectrum of Salmonella infections in immunocompromised patients. Context : A 37-year-old male with sickle cell disease presented with rpiagihnt -isni dtehde f ar icgi ah lt sjwa we l l ai nngd. Twwaos wp reeeskcsr ipbrei od r, ahme odxei cviel ll ionp/ecdl asvwu leal nl i antge afnodr right-sided parotitis. Symptoms worsened, spreading to the preauricular area. He denied fevers, sore throat, chest pain, and swhaosrtanfeebssriolef (b9r9ea.5th but reported chills and sweats. On examination, he ℉ ) with stable vitals. Oral assessment revealed mild milky white discharge from Stenson’s duct and fluctuant swelling of the rr ii gg hh tt pcahreoetki d egxl at ennddei nn gl a rt go e mt heen pt rweiat uh rai csuul sa pr eac rt ee da . aCbTs c ei ms sa(gFi ni ggu rseh 1o )w. e d Management : He was admitted, started on ampicillin/sulbactam and lveadn ct oo ma yfci inne, annede dElNe Ta scpo inrsaut ilot ant ibo ino pwsays oonb tDa ianye d4 ., Wr eovresael ni ni ng g s y m p t o m s Salmonella . At rne tai tbmi oetni ct s, s wi genri ef i csawn it t cs wh eedl l i tnog cpeefrt sr ii sa txeodn, ep raonmd pmt i ne gt r ao dn di di tai zoonl ae l. i Dmeasgpi int ge (Figures 2 and 3), drainage in the OR, and Penrose drain placement. MRI revealed persistent right parotitis with residual abscess (4 cm) 4an-wdemekasctoouidrsaeirofceclilperofffulosxioancsin. .He was discharged after two days with a Outcome : At follow-up, tenderness improved with minimal drainage. Hp oe u dl ter ny i/eedg gr se cbeuntt rgeapsot rr ot ei nd t eas t1i n0 -adl ai yl l nceespsh oa lre xe ixnp oc souurres et oa umn od ne rt hc opo rki eodr for a parietal scalp swelling near an old injury. Case Report

Figure 1. . CT soft tissue with contrast in ED . Marked asymmetric enlargement right ptharrooutigdhgoluatntdhewritighhstunsepcekc.te. d parotid abscess. Reactive right cervical adenopathy present

Figure 2. CT soft tissue without contrast . Persistent signification fullness of tissues at trheeactRivIGeHlyTmnpehcnkopdoesst. erior to the parotid gland. Persistent multi position right-sided

Table 2. MRI orbit face/neck. Persistent right parotiditis, mastoid air cells show ewf rf ua spipoinnsg/ af lruoi du .nSdutpheer af inc it ae lr ifol ur i md ac rogl lienc ot ifotnh ei nu tphpee rs osftte rt insos culeesi dwo mh i ac hs t os hi do wmsu sdcel ee pc oemx tpe antsi ibol ne wsteitrhnorcelesiidduoamlasatbosicdemssusocfle.4 cm, Significant myositis changes in the proximal right

Acknowledgements

The patient in this study provided written informed consent prior to participation

2025 Research Recognition Day

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