A rare case report of Salmonella infection: severe necrotizing pneumonia with empyema in an immunocompetent child.

Salmonella is a gram-negative bacillus that typically causes gastrointestinal disease and rarely affects the pulmonary system, particularly in immunocompetent children. We report a 4-year-old immunocompetent Saudi boy who presented with severe respiratory distress requiring intubation and was found to have left-sided pleural effusion. Pleural fluid and tracheal aspirate cultures grew Salmonella species, while blood, stool, and CSF cultures were negative. Chest computed tomography revealed complicated empyema with necrotizing pneumonia. Despite appropriate antimicrobial therapy and supportive care, the patient deteriorated and ultimately required extracorporeal membrane oxygenation (ECMO). This case illustrates a rare and severe presentation of complicated pulmonary Salmonella infection in an otherwise healthy child, occurring either following or concurrent with influenza infection. It underscores the critical importance of timely source control and highlights the potential association with cytokine storm in severe disease progression.