Salmonella Septic Hip Arthritis in Immunocompetent Children: Three Case Reports and Literature Review

Septic arthritis is an orthopaedic emergency, especially considering the pediatric population. Salmonella is a less common aetiologic factor for septic arthritis compared with other Gram-negative bacteria. Its isolation in immunocompetent children and infants is quite rare, with an estimated incidence of 0.1% to 0.2% of septic arthritis cases among children. We report three rare cases of hip septic arthritis with Salmonella as a confirmed pathogen in immunocompetent children, with two of them being infants. The main symptoms that occurred in all three cases were fever, hip pain/no bearing, and diarrhoea, as well as elevated levels of WBC, C-reactive protein and ESR. The duration of their hospitalization was 20, 26 and 52 days. One case was treated only with antibiotics, while the other two with surgical drainage with/without arthrotomy. All cases had a follow-up of at least one year, with only one of the infants having the femoral head in a subluxated position and early signs of osteonecrosis. Fluoroscopy-assisted closed reduction had to be performed and maintained by hip spica. A new femoral epiphysis was formed at the time of the last follow-up 2.5 years later. Our case series highlights the possibility of Salmonella typhi septic hip arthritis in immunocompetent individuals. Therefore, Salmonella species must always be kept in mind during the differential diagnosis of septic arthritis in a clinically relevant setting.