A Rare Case of Salmonella Enteritidis Sinusitis

Nontyphoidal <i>Salmonella</i> is a common cause of gastroenteritis but can also lead to bacteremia and extraintestinal infections, including meningitis (more frequent in children and infants), endovascular infections (e.g., endocarditis and infected aneurysms), urinary tract infections, and bone or bone marrow infections (e.g., septic arthritis and osteomyelitis). However, ENT complications are rare. We present the first-ever case of <i>Salmonella</i> Enteritidis sinusitis. A 77-year-old woman experienced worsening right facial swelling and pain persisting for one month. Upon examination, she exhibited right cheek swelling with induration, warmth, and redness extending to the infraorbital region. Computed tomography (CT) scan findings revealed a heterogeneous mass in the right maxillary sinus with evidence of locoregional destruction. Additionally, an abscess was detected in the right buccal space. During surgery, the right maxillary sinus was found to contain pink frond-like tissue and white-grey concretions. Histological examination revealed squamous cell carcinoma (SCC). Magnetic resonance imaging (MRI) showed enlarged right cervical lymph nodes, raising suspicion for metastatic nodal spread. Further investigation indicated the presence of <i>Salmonella enterica</i> serovar Enteritidis in tissue cultures. The patient was ultimately diagnosed with stage IVA cT3N2bM0 right maxillary sinus squamous cell carcinoma (SCC) with concomitant <i>Salmonella</i> Enteritidis sinusitis. Prior to the first surgery, she received treatment with amoxicillin-clavulanate for eight days, followed by six weeks of ciprofloxacin (culture-directed treatment) and two weeks of metronidazole to cover for anaerobes. Subsequently, she underwent a total maxillectomy, neck dissection and reconstruction utilizing a free anterolateral thigh flap, and adjuvant radiotherapy and is recovering well. We discuss the possible mechanism of <i>Salmonella</i> Enteritidis infection in relation to kombucha intake.