Refractory, Concurrent Salmonella Osteomyelitis, and Septic Arthritis in Immunocompetent and Immunocompromised Pediatric Patients

Pediatric osteomyelitis and septic arthritis are rare but serious complications of Salmonella infection that present significant challenges due to symptom overlap. We describe 2 pediatric cases of refractory Salmonella osteomyelitis with concurrent septic arthritis of the hip. Clinical, imaging, and laboratory findings were reviewed. This report includes a previously healthy 10-month-old female with Salmonella bacteremia, right femoral osteomyelitis, and hip septic arthritis and a 5-year-old male with alpha thalassemia trait with clinical and imaging evidence of osteomyelitis and septic arthritis. Despite initial surgical and antibiotic management, repeat arthrotomies with prolonged IV therapy were necessary. At 6 months, femoral head necrosis was observed in patient 1 while patient 2 demonstrated full recovery. These cases highlight the potential severity and recurrence of Salmonella bone and joint infections in both immunocompetent and immunocompromised pediatric patients. Successful management required multiple surgical debridements and prolonged antibiotic therapy.