When Salmonella Strikes the Brain: A Systematic Review of Non-Typhoidal Salmonella Infections with Central Nervous System Involvement in Immunosuppressed Patients.

Central nervous system (CNS) infections caused by Salmonella species (spp.) are exceptionally rare in adults but are associated with significant morbidity and mortality, particularly in immunocompromised individuals. Clinical presentation is often nonspecific, including fever, headache, or altered mental status, while imaging may demonstrate meningeal enhancement, abscesses, or cytotoxic lesions. We present a systematic review of non-typhoidal Salmonella spp. infections involving the CNS across various immunosuppressive contexts, illustrated by the case of a 38-year-old HIV-positive man with well-controlled infection. He developed disseminated Salmonella enterica infection, with bacteremia, septic arthritis, and ultimately corpus callosum involvement, following chronic self-administration of corticosteroids for cluster headaches. This case underscores that corticosteroid exposure can precipitate systemic dissemination even in patients with preserved CD4 counts. Although this condition carries a high risk of mortality, early recognition, targeted antibiotic therapy, and careful multidisciplinary management of underlying immunosuppression are critical to improving survival and minimizing neurological sequelae.