Successful treatment of refractory septic arthritis caused by salmonella and staphylococcus aureus with preservation of graft function in a long-term renal transplant recipient by total withdrawal of immunosuppressants

An 18-year-old female had received a 2 HLA incompatible renal transplant 10 years before. She initially presented with septic arthritis and osteomyelitis caused by Salmonella enterica co-infected with Staphylococcus aureus of her left knee with development of secondary septic arthritis of the right knee and left shoulder. This was complicated by a recurrent subcutaneous abscess and intermittent high fever. The infection was successfully treated with a combination of a prolonged course of antibiotics, twice joint washout and debridement, repeat aspiration, hyperbaric oxygen therapy and a total withdrawal of immunosuppressant resulting in good joint function and preservation of normal renal graft function. In our experience, it was possible to keep stable renal graft function in spite of complete withdrawal of immunosuppressants for 12 months in a recipient with 2 HLA mismatches.