# Non-typhoidal Salmonella Bacteremia as a Diagnostic Clue to Gastric Cancer With Isolated Bone Metastasis: A Case Report

## TL;DR

A rare case shows that Salmonella infection can be an early sign of gastric cancer with bone metastasis, highlighting the need for thorough diagnosis in such infections.

## Contribution

This case report presents a rare association between non-typhoidal Salmonella bacteremia and gastric cancer with isolated bone metastasis.

## Key findings

- Salmonella enterica bacteremia was the initial presentation of gastric adenocarcinoma with bone metastasis.
- Persistent symptoms after antibiotic treatment led to the discovery of an ulcerated gastric lesion and metastatic bone disease.
- The case underscores the importance of considering malignancy in patients with unexplained Salmonella bacteremia.

## Abstract

We report a rare case of Salmonella enterica bacteremia as the initial presentation of gastric adenocarcinoma with isolated bone metastasis. A 65-year-old woman presented with persistent lumbar and cervical pain, night sweats, tremors, and worsening respiratory failure. Blood cultures grew S. enterica, leading to targeted antibiotic treatment with ceftriaxone. Despite therapy, fever and inflammatory markers persisted. Upper endoscopy revealed an ulcerated gastric lesion, and biopsy confirmed signet ring cell gastric adenocarcinoma. Imaging showed diffuse vertebral lesions, and bone biopsy confirmed metastatic disease. The patient’s condition was complicated by gastrointestinal bleeding and progressive decline, making curative treatment unfeasible; she was transitioned to palliative care. This case highlights non-typhoidal Salmonella (NTS) bacteremia as a possible early indicator of malignancy and emphasizes the need for thorough diagnostic evaluation in patients with unexplained bacteremia.