(A211) Chronic Salmonella Lymphadenitis in a Diabetic Patient

Introduction: Salmonella infections typically present as gastroenteritis but can rarely manifest as extraintestinal abscesses. This report describes a unique case of a deep neck abscess caused by Salmonella species in a diabetic patient.

Methods: Retrospective chart review.

Results: A 51-year-old man with poorly controlled diabetes (HbA1c 11.6%) and hypertension presented with a three-month history of progressive left neck swelling, night sweats, and unintentional 15-pound weight loss. The mass, initially indolent, underwent a three-week period of rapid change prompting presentation. Changes included onset of pain, rapid enlargement, erythema, odynophagia, and fever, though no gastrointestinal symptoms. Imaging revealed multistation left-sided cervical lymphadenopathy, including a dominant centrally necrotic cystic lymph node in left level 2A (3.0 × 4.2 cm). Blood cultures, collected after antibiotics began, were negative. Concerned for malignancy, an interventional radiology-guided biopsy and fluid aspiration was performed, yielding purulent fluid and pathology consistent with benign reactive lymphadenopathy. Cultures demonstrated Salmonella species. Persistent symptoms and residual fluid prompted surgical incision and drainage. Cultures revealed Gram negative bacilli and no acid-fast bacilli. Pathology showed reactive lymph node tissue with paracortical hyperplasia, suppurative granulomas, and polytypic plasmacytosis, consistent with a reactive process without malignancy. The patient received ampicillin-sulbactam, followed by piperacillin-tazobactam and linezolid, eventually ceftriaxone, and finally outpatient trimethoprim-sulfamethoxazole. Post-procedure imaging showed improvement in lymphadenopathy and symptoms continued to resolve at follow-up.

Conclusions: Although initially concerning for malignancy, this case of cervical lymphadenopathy with abscess formation was found to be a chronic Salmonella infection of unknown source. Management required multidisciplinary care and highlighted the vigilance required in addressing rare infections in diabetic patients.