Salmonella Arizonae Bacteremia Associated with Septic Arthritis Following Consumption of Rattlesnake Capsules in a Patient with Idiopathic Thrombocytopenic Purpura (ITP) on Chronic Steroid Therapy.

Background: Folk medicine plays an important role in some populations in the United States. In particular, the use of rattle snake powder is becoming increasingly popular among the Mexican-American population along the US-Mexico border. Infections associated with the ingestion of this preparation have increasingly been reported in this country. We present a patient who presented with Salmonella Arizonae bacteremia and septic arthritis with underlying ITP on chronic treatment with steroids and surreptitious use of rattle snake powder.

Case Report: A 53 year-old Mexican -American male with a past history of ITP on chronic oral prednisone with intact spleen was admitted with fever, chills, and an acute onset of pain, swelling and tenderness of his left knee. On admission to the hospital, his temperature was 101.5 F, blood pressure was 124/68, and pulse 102/min. The physical findings were significant for swelling and tenderness to the left knee with evidence of synovial effusion and restricted range of motion. The white blood cell count was 18,000cu/mm. Culture of the patient’s left knee synovial fluid aspirate grew Salmonella Arizonae, as did his blood cultures. The pathogen was sensitive to 3^rd generation cephalosporins and quinolones, and he was treated with intravenous ceftriaxone for 2 weeks with resolution of the bacteremia and improvement of the septic knee. He subsequently underwent a total knee arthroplasty, and follow up 1 year later revealed no evidence of persistent infection. After the pathogen identification, a careful alternative medicine history revealed the consumption of rattle snake powder preparation intended for treatment of his arthritis and ITP.

Conclusion: Physicians should be aware of Salmonella Arizonae associated illnesses in both immunocompetent as well as immunosuppressed patients. Because the surge of interest in complementary and alternative medicine, a careful history should be elucidated, especially in immunocompromised patients who present with this syndrome.