eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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2/2015
vol. 11
 
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Letter to the Editor
Non-typhoidal Salmonella abscess in a patient with a large thymoma: a rare presentation and review of the literature

Irene J. Lo
,
Wilbert S. Aronow
,
Irlna I. Tantchou
,
Rocco Lafaro
,
Abraham Marav
,
Arif Muslim
,
Suryanarayana Pothula

Arch Med Sci 2015; 11, 2: 453–457
Online publish date: 2015/04/23
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Salmonella infection commonly occurs in the gastrointestinal tract secondary to fecal-oral transmission of the bacterium. Extraintestinal Salmonella is typically seen in the biliary system and is very rarely observed in the thoracic cavity. Salmonella infection in the thymus is an even more unusual presentation of extraintestinal Salmonella , with only one previous case reported in the literature. Thymic abscesses are already a rare clinical entity and have been reported to result from infection with Staphylococcus aureus. We report a case of a 59-year-old man with a non-typhoidal Salmonella infection of a large symptomatic thymoma that was treated with surgical drainage and antibiotic therapy.
A 59-year-old Pakistani man was admitted to our hospital in January, 2013 with a large, symptomatic anterior mediastinal mass. During the year prior to admission at our institution, the patient had become progressively more short of breath and had significantly decreased exercise tolerance. The patient was also experiencing intermittent fevers and leukocytosis. The patient was evaluated in Pakistan by a cardiologist, who performed an echocardiogram and a stress test. The echocardiogram revealed a mediastinal and right pleural base mass.
Additional radiological imaging was subsequently obtained to further evaluate this mass. A chest X-ray was obtained which confirmed a large mass in the right pleural space. Computed tomography (CT) scan of the chest also demonstrated a large inhomogeneous mass with almost near total compression of the right atrium and total compression of the lung with significant compression atelectasis. A biopsy of the mass was performed which indicated a diagnosis of thymoma.
The patient traveled to the United States for further work-up and management. A CT scan of the chest obtained in Pakistan revealed a persistent right pleural based mass with compression of the right atrium and right lung (Figure 1). The pathology slides were reviewed by two separate institutions, and the diagnosis was confirmed to be thymoma. After discussion with the patient and his family regarding treatment options, the risks of surgery, and the benefits of surgery, the patient elected to undergo surgical resection of the mass. During his pre-operative evaluation, the patient was noted to be febrile to 103 with significant leukocytosis of 30,000 on his laboratory results....


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