Subcutaneous abscess caused by extended-spectrum beta-lactamase-producing Salmonella senftenberg in a type 2 diabetic--a case report.

Sulmonellu organisms occur worldwide and are responsible for a broad spectrum of clinical syndromes, including self-limited gastroenteritis, bacteremia and vascular infection, enteric fever, and metastatic focal infections, although infection may be asymptomatic.’ Here we report a case of subcutaneous abscess caused by multiresistant Salmonella senftenberg. A 62-year-old obese female presented with swelling of 1.5 days’ duration with multiple ulcers in the left lower limb. She had suffered intermittently with the same symptoms for 4 years, and had been diagnosed and operated on for varicose veins (left saphenofemoral junction ligation with great saphenous vein stripping and bilateral below-knee perforator ligation) in the same hospital 18 months previously. She had been a known type 2 diabetic patient for 8 years, and was on mixtard insulin twice daily (9 and 4 units). Local examination revealed diffuse, tender swelling, with multiple blebs and ulcers occupying the upper and lateral two-thirds of the left lower limb. Laboratory investigations done at the time of admission were within normal limits, except for a random blood glucose level of 480 mg/dL. S. senftenberg was isolated from the aspirated pus of the subcutaneous swelling. The isolate was an extendedspectrum B-lactamase (ESBL) producer by double disk synergy test, and was sensitive to trimethoprim-sulfamethoxazole, amoxicillin-clavulanic acid and imipenem by the Kirby-Bauer disk diffusion method. Urine and blood cultures were sterile. Stool and repeat pus culture yielded S. senftenberg with a similar antibiotic susceptibility pattern. The Widal test was negative. The patient recovered well after specific antibiotic treatment, skin graft to close the wound, and diabetic management. There is a tendency for SuZmonellu species to localize in injured or damaged tissue or in sites of malignancy.2 In the present case, the patient was diabetic and probably a carrier of S. senftenberg, with varicose veins, suffering