Fatal Salmonella septicaemia with disseminated intravascular coagulation and renal failure

This case report describes four elderly patients with fatal Salmonella septicemia complicated by disseminated intravascular coagulation (DIC) and acute renal failure. Three patients were infected with Salmonella typhimurium and one with S. abony—organisms not typically associated with severe invasive disease. All patients presented with persistent diarrhea, developed hypotension, oliguria, and died within one week of hospitalization despite antimicrobial and supportive therapy. Clinical and laboratory findings indicated DIC, including prolonged coagulation times, elevated fibrin-degradation products, thrombocytopenia, and schistocytes in blood films. Necropsy confirmed DIC histologically through identification of haematoxylinophil bodies in renal and pulmonary microcirculations, indicating fibrin deposition. The authors attribute the unusual severity to multiple predisposing host factors identified in these patients: advanced age, previous gastric resection, use of gastrointestinal motility-altering medications, and immunocompromise. The case series illustrates that while Salmonella-related mortality is generally rare in Britain, extra-intestinal salmonella infections carry substantially higher mortality risk and can trigger life-threatening complications through endotoxin-mediated mechanisms.

Key findings

• Four elderly patients with Salmonella septicemia (3 S. typhimurium, 1 S. abony) developed fatal disseminated intravascular coagulation and acute renal failure despite appropriate antimicrobial therapy.
• Histological examination confirmed DIC in all cases by demonstrating haematoxylinophil bodies in renal and pulmonary microcirculations, characteristic of intravascular fibrin deposition.
• Multiple host risk factors were identified including advanced age, prior gastric surgery, use of antimotility agents, and possible immunosuppression, predisposing these patients to severe invasive disease.
• Extra-intestinal Salmonella infections, though representing only 1.7% of isolates, accounted for 57% of salmonella-related deaths in Britain (1977-1978 surveillance data).
• Gram-negative bacteremia carries significantly higher rates of endotoxic shock and DIC (occurring in ~1 in 3 patients) compared to gram-positive infections, with 60% mortality even with treatment.