A 21-Year-Old Returned Traveller with Typhoid Fever Complicated By a Multifactorial Anemia and Splenic Infarction

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C. Benjamin Lai
Eric Coomes
Molly Whalen-Browne
Christian Kraeker

Abstract

Typhoid fever is a rare disease in North America. We present the case of a 21-year-old female who developed invasive Salmonella typhi infection after returning from rural Pakistan. The patient presented with classic signs of enteric infection including high fever, diarrhea, and a tongue coated in white patches. The patient developed hematologic complications of anemia and splenic infarction. Investigations, imaging studies and treatment are discussed. The case outlines both common and uncommon complications of typhoid fever and reminds the clinician of its importance in the differential of fever in the returning traveller. Four key point to consider are: 1. Fever in a returning traveler has a broad differential diagnosis, but concurrent abdominal symptoms should result in blood cultures to assess for gram-negative bacteria. 2. Ceftriaxone, azithromycin, or fluoroquinolones are the treatments of choice for Salmonella typhi, although clinicians should be aware of increasing resistance to the latter and base treatment on sensitivity testing. 3. Anemia during typhoid fever can be multifactorial and include elements of gastrointestinal blood loss, hemolysis and transient marrow suppression. 4. Spleen involvement can lead to complications such as splenic infarction or abscess formation.

 

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