# Acute Respiratory Distress Syndrome and Spondylitis Secondary to Salmonella Bacteremia

## TL;DR

A healthy man developed severe respiratory and spinal complications from a Salmonella infection, which is rare and highlights unusual disease progression.

## Contribution

This case report documents the rare co-occurrence of ARDS and spondylitis in a healthy adult with non-typhoidal Salmonella bacteremia.

## Key findings

- Non-typhoidal Salmonella infection led to ARDS and spondylitis in a previously healthy adult.
- Respiratory failure improved rapidly with antibiotics, while spondylitis required prolonged treatment.
- The case suggests possible mechanisms for ARDS development in Salmonella infections.

## Abstract

Salmonella enterica subsp. enterica includes both typhoidal and non-typhoidal serovars. The former are more likely to cause systemic infections such as typhoid fever, while the latter typically result in localized gastroenteritis. The main symptoms of non-typhoidal Salmonella (NTS)infection are transient diarrhea, which typically resolves within approximately five days. However, in a few cases, it may worsen and cause multiorgan dysfunction.

A 39-year-old healthy male developed an NTS infection, which likely manifested as enteritis, followed by Salmonella bacteremia, spondylitis, and acute respiratory failure. The patient required mechanical ventilatory support due to rapidly progressive respiratory failure; however, the respiratory condition improved within a short period following antibiotic therapy. Subsequently, prolonged antibiotic treatment was administered for spondylitis.

While bone manifestations of NTS bacteremia are frequently reported, cases complicated by both acute respiratory distress syndrome (ARDS) and spondylitis are rare. The mechanism of pyogenic spondylitis development by Salmonella is thought to involve hematogenous infection associated with bacteremia. On the other hand, the pathogenesis of ARDS remains unclear. However, direct lung tissue damage caused by Salmonella and secondary lung injury resulting from systemic inflammatory response syndrome may play a role. This case highlights an unusual presentation in a relatively young and otherwise healthy adult.