A Patient with Typhoid Hepatitis

M Vitanata Arfijanto,Isty Rindryastuti

doi:10.24871/2222021154-158

Abstract

Typhoid hepatitis is typhoid fever accompanied by symptoms of jaundice, hepatomegaly and abnormal liver function tests. The incidence varies between 0.4% -26% of typhoid fever patients. We report a case of a 34-year-old male, presented with fever, epistaxis, gastrointestinal symptoms, thrombocytopenia and elevated AST/ ALT, thus the patient was first diagnosed as dengue hemorrhagic fever grade II. On day 9th the signs and symptoms were persisted, Ig M and Ig G Dengue was negative. Then we evaluated the virus marker for hepatitis and blood culture. The results were negative for HBsAg, anti HCV and Ig M anti HAV, but Salmonella typhi detected on blood culture. The patient was treated with ceftriaxone 1000mg bid iv and get better then discharged from hospital.

Highlights

Typhoid fever is a common infectious disease in developing countries, associated with high morbidity and mortality, becoming a global health problem
Based on that data we dignosed the patient as suspected typhoid hepatitis + Acute Kidney Injury (AKI) improved + Euvolumic hyponatremia + Corrected hypokalemia, with diagnostic and therapeutic planning: CBC &peripheral blood smear, direct bilirubin, total bilirubin, aspartate transaminase (AST) & alanine transaminase (ALT), stool analysist, Ig M Salmonella, stool and blood culture, plain abdominal radiograph, HIV 3 methods serology test, abdominal ultrasonography, bed rest, diet high calories high protein 2000 kcal/day low fiber, NaCl 0.9% 1500mL/24h iv, ceftriaxone 1g/12h iv, ranitidine 50mg/24h iv, paracetamol 500mg+n-acethyl sistein 200mg 1tab/8h prn
Typhoid fever is caused by S typhi or S paratyphi, spread through the ingestion infectious doses of bacteria from contaminated water or food which is affected by poor sanitation.[6]

Summary

Introduction

Typhoid fever is a common infectious disease in developing countries, associated with high morbidity and mortality, becoming a global health problem. Based on that data we dignosed the patient as suspected typhoid hepatitis + Acute Kidney Injury (AKI) improved + Euvolumic hyponatremia + Corrected hypokalemia, with diagnostic and therapeutic planning: CBC &peripheral blood smear, direct bilirubin, total bilirubin, AST & ALT, stool analysist, Ig M Salmonella, stool and blood culture, plain abdominal radiograph, HIV 3 methods serology test, abdominal ultrasonography, bed rest, diet high calories high protein 2000 kcal/day low fiber, NaCl 0.9% 1500mL/24h iv, ceftriaxone 1g/12h iv, ranitidine 50mg/24h iv, paracetamol 500mg+n-acethyl sistein 200mg 1tab/8h prn.

Results

Conclusion