Salmonella septic arthritis in systemic lupus erythematosus. The importance of chronic carrier state.

Salmonella bacteremia is more frequently seen in hospitalized patients with systemic lupus erythematosus (SLE) than in hospitalized patients with other diseases. In our experience. Salmonella enteritidis septic arthritis is more common in SLE than in patients with others connective tissue diseases. We report that 4 of 7 patients with SLE with glomerulonephritis and history of Salmonella enteritidis septic arthritis were chronic carriers of this bacteria, since positive cultures were obtained from feces, bone marrow and bile fluid from 20 84 months after Salmonella arthritis developed. In contrast, none of 24 patients with SLE without a history of Salmonella arthritis were chronic carriers and only one of 12 patients with rheumatoid arthritis had positive bile culture to S. typhi while otherwise being asymptomatic. From our study we conclude that patients with active SLE who have gomerulonephritis are at increased risk of becoming chronic carriers of Salmonella enteritidis and of developing Salmonella arthritis once combined prednisone cyclophosphamide treatment has begun. A chronic Salmonella carrier state must be ruled out in patients with active SLE living in endemic zones, before initiating immunosuppressive therapy.