Salmonella bonariensis Salmonellosis , Rhabdomyolysis , and Acute Renal Failure

Dr. C. Lagarde, Service de Néphrologie, Hôpital Universitaire Dupuytren, F-87042 Limoges Cedex (France) Dear Sir, In contrast to Salmonella typhi infections, infections due to Salmonella choleraesuis and Salmonella enteritidis occur primarily in animals. Accidental cross-contamination in man can occur and results most frequently in self-limited acute gastroenteritis. In 1941 a new 5*. enteritidis serotype ‘Salmonella bonariensis’ was isolated from pig mesenteric lymph nodal tissue [1]. We report a case of S. bonariensis salmonellosis with acute enteritis followed by rhabdomyolysis and acute renal failure. Mrs. L.C., 84 years old, had been previously in good health when she developed acute diarrhea on July 13, 1985. The diarrhea resolved spontaneously within 3 days, but was followed immediately by severe diffuse myalgia. The serum potassium level was 4.4 mmol/l and the serum creatinine level 500 μmol/l (1 month previously 98 μmol/ 1). On July 20, the patient was hospitalized with severe edema of the lower extremities and persisting diffuse myalgia. There was no gastrointestinal symptomatology. Her temperature was 37.8 °C, and the blood pressure was 130/80 mm Hg. The remainder of the physical examination, in particular the neurologic examination, was normal. The urine was clear. The electrocardiogram was normal, as was a neuromuscular biopsy. Laboratory findings revealed a hemoglobin level of 10 g/dl, a leukocyte count of 9,900/mm3 (84% polynuclear cells), and a platelet count of 277,000/mm3. The following serum levels were obtained: urea 36 mmol/l, creatinine 876 μmol/l, sodium 134 mmol/l, chloride 94, potassium 4.8, bicarbonate 19 mmol/l, creatinine phosphokinase 24,360 IU/1 (normal < HO), lactate dehydrogenase 3,676 (normal < 330) serum glutamic-oxaloacetic transaminase 782 (normal < 26), serum glutamic-pyruvic transaminase 472 (normal < 27), and aldolase 7.3 IU/1 (normal < 3). Three blood cultures were negative. The urine leukocyte count was 4,000/ml, red cell count 4,800/ml, proteinuria 0.30 g/24 h, and no bacteriuria was present. Urine myoglobin levels were determined twice and were both negative. Two stool cultures obtained 24 h apart both revealed S. bonariensis (6,8: i: e, n, x). On July 25, the serum creatinine level was 1,266 μmol/l. The patient required hemodialysis twice. No therapy was administered for the salmonellosis, since the intestinal infection had become asymptomatic at the time of hospitalization. Upon discharge, on August 5, the serum creatinine level was 300 μmol/l, and serum enzyme levels had returned to