Patient’s History • A 7-year-old girl was well until about 3 weeks ago, when she began complaining of being “tired all the time.” • On exam, her temperature is 38°C and there is tenderness below the right knee. • Hemoglobin: 10.2; WBC: 9600 with increased neutrophils. • A sickle cell prep shows a moderate sickling tendency. • Gram negative rods grew in the blood culture. DIAGNOSIS • Osteomyelitis caused by Salmonella species – Sickle cell anemia predisposes to osteomyelitis caused by Salmonella species – The abnormally shaped sickle cells are trapped in the small capillaries of the bone and cause microinfarcts. – These microinfracts enhance the likelihood of infection by Salmonella.