Is Salmonella Infection Another Possible Trigger for Polyarteritis Nodosa?

Polyarteritis nodosa is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries. Most cases of polyarteritis nodosa are idiopathic but multiple infectious agents have been associated with this disease. We present a clinical case of a 72-year-old male with fever, diarrhoea and haemodynamic instability, diagnosed with a bacterial infection caused by Salmonella Typhi. One week after clinical resolution of the infection, the patient developed purpuric lesions with ulcers, pustules and necrotic areas accompanied by testicular pain and weight loss of 5 kg over the previous 15 days. A skin biopsy was performed and it revealed typical histologic signs of polyarteritis nodosa. The aetiologic association between bacteria of the genus Salmonella and polyarteritis nodosa has been previously described in the scientific literature but seldom meeting classification criteria and with histologic confirmation. LEARNING POINTS: Polyarteritis nodosa is a systemic necrotizing vasculitis associated with a multitude of aetiologic agents. Salmonella infection might be a possible trigger for the development of polyarteritis nodosa. A high index of suspicion and awareness is essential for a swift diagnosis and treatment of this disease.