Travel-Associated Salmonella mbandaka Sacroiliac Osteomyelitis in a Healthy Adolescent

Pyogenic infections of the sacroiliac joint are rare and usually caused by Staphylococcus aureus. We describe a case of a 16 year-old gymnast who was subsequently diagnosed with Salmonella mbandaka sacroiliac osteomyelitis with adjacent psoas abscess and hepatitis one week after returning from a holiday in Crete. This case highlights a rare presentation of a common travel-associated foodborne infection. 1. Introduction Pyogenic sacroiliitis is uncommon in children, representing only 1%-2% of all cases of septic arthritis, and is usually caused by Staphylococcus aureus [1]. Initial symptoms are often nonspecific and difficult to differentiate from septic arthritis of the hip. Diagnosis of pyogenic sacroiliitis is difficult because of its deep location and may be delayed due to the lack of specific clinical signs, which in turn may lead to complications such as sequestration or abscess formation, prolonged period of sepsis, and long-term joint deformity [2]. Here, we describe an extremely rare case of Salmonella mbandaka sacroiliitis with psoas abscess, osteomyelitis, and hepatitis in an adolescent gymnast presenting one week after returning from a holiday in Crete, along with a review of the published literature on previously reported cases. 2. Case Report A previously healthy 16-year-old girl presented to our hospital emergency department with sudden onset of back pain and difficulty mobilising one week after returning from holiday with her twin sister to Crete. She was an avid gymnast who trained four times a week but denied any previous injuries. Clinical examination was unremarkable, and she was discharged home with a diagnosis of musculoskeletal pain. Over the next 24 hours, her pain worsened and progressed to her left buttock, radiating down the back of her leg, which prompted her family to consult a private adult neurologist. An MRI scan of her spine was performed and the neurologist diagnosed sciatica-piriformus syndrome, probably secondary to a gymnastic injury. The following day, however, she developed a high fever with rigors, but no diarrhoea or vomiting, and re-presented to our emergency department. At that time, her temperature was 40°C and she reported a 10/10 pain score. Physical examination revealed 4？cm nontender liver and 3？cm spleen. There was tenderness on palpation over both sacroiliac (SI) joints, worse on the left with pain radiating to the left upper thigh. Active and passive left hip flexion and internal/external rotation were both severely restricted because of excruciating pain. Her position of comfort was lying on her right