A 60–year–old male with sarcoidosis and cryptogenic cirrhosis presented with increasing dyspnea and abdominal distention. He underwent a therapeutic and diagnostic paracentesis. The cell count was consistent with spontaneous bacterial peritonitis (cloudy fluid with 1590 WBC and 67% neutrophils and 28% lymphocytes). The cultures grew ceftriaxone susceptible salmonella non typhi (serotype 4512i). Following antibiotics a repeat paracentesis demonstrated clearing of the infection.
Salmonella, a motile, gram negative bacilli is primarily known for causing gastroenteritis, enteric fever and focal infections and is uncommonly seen in the United States (250 cases per year with 80% associated with foreign travel). Spontaneous bacterial peritonitis (SBP) caused by salmonella is rare but has been reported in association with immunosuppressive disorders including HIV and lymphomas. Sarcoidoisis, to our knowledge, has not been previously reported as a contributing factor but might be expected to be included in such a list because it involves the reticuloendothelial system and is affected by the immunogenetic status of the patient. Our patient had a greater degree of neutrophilia than is usually seen in association with HIV or lymphomas and may be a differential point when confronted with a similar patient presentation.
1) Salmonella although commonly thought of in association with typhoid fever, can be a rare cause of spontaneous bacterial peritonitis in cirrhotic patients. 2) Immunosuppressive illnesses (HIV, Lymphomas) increase the risk of salmonella as a causative agent in such cases. 3) Sarcoidosis, although previously unreported in similar cases can be a contributing factor leading to infection with salmonella species.