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I was interested to read the “Lesson of the month” on salmonella arteritis in a 70 year old Afro-Caribbean man.1 The discussion mentioned that male sex and pre-existing atherosclerosis are risk factors for salmonella arteritis and that the condition is extremely uncommon below the age of 50.
No mention was made of the possibility of sickle cell disease in this man. Sickle cell disease may be complicated by salmonella infection, rarely producing an osteomyelitis, and I should be interested to know if haemoglobin electrophoresis was carried out, and whether in fact the sharp drop in haemoglobin might be accounted for by a sickle cell crisis.
It is a valid point that sickle cell disease can be complicated by salmonella infection and as a sequel salmonella osteomyelitis. This usually follows a painful crisis, which is more common in male than female patients and has an increased incidence between the ages of 15 and 25. An episode of painful crisis lasting for more than two weeks and associated with a temperature of 38°C or more should raise the suspicion of osteomyelitis, and the most common organism is salmonella followed by Staphylococcus aureus. Radiological changes are often only apparent up to four weeks after the onset of illness. Salmonella infection is also recorded in young children with sickle cell disease and episodes of vascular occlusion affecting the bones of the hand and feet, leading to dactylitis. Blood cultures are therefore always indicated in dactylitis when associated with sickle cell disease, and salmonella infection as a complication is well documented.1
Our patient did in fact have a haemoglobin electrophoresis carried out during his illness and this showed a normal adult haemoglobin pattern and no evidence of haemoglobinopathy.
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