Abstract
A 25 year old previously healthy male presented with low grade intermittent fever for ten days and confusion for two days. On examination he was febrile and confused, making abnormal unpurposeful gestures with his hands. He was not aggressive. There was no nuchal rigidity or cervical lymphadenopathy. He was started on empirical intravenous antibiotics and steroids to cover meningo encephalitis. He had a marginally elevated CRP, a normal full blood count and an unremarkable CSF analysis. The patient was started on chloramphenicol to cover typhus encephalitis. The CSF culture was sterile. Salmonella enterica serovar Typhi was isolated from blood culture.
Highlights
A 25 year old previously healthy young man from the outskirts of Jaffna with no family history of any psychiatric illness presented with fever accompanied by chills and rigors of ten days duration
Presenting Concerns The patient was admitted to the local hospital on the 6th day of fever as there was no response to antipyretics
A clinical diagnosis of typhoid fever complicated with neuropsychiatric disturbances was made which was confirmed with a positive blood culture for Salmonella Typhi sensitive to chloramphenicol, ampicillin, ciprofloxacin, norfloxacin, cotrimoxazole, ceftriaxone, gentamicin and amikacin
Summary
A 25 year old previously healthy young man from the outskirts of Jaffna with no family history of any psychiatric illness presented with fever accompanied by chills and rigors of ten days duration. Presenting Concerns The patient was admitted to the local hospital on the 6th day of fever as there was no response to antipyretics. A clinical diagnosis of typhoid fever complicated with neuropsychiatric disturbances was made which was confirmed with a positive blood culture for Salmonella Typhi sensitive to chloramphenicol, ampicillin, ciprofloxacin, norfloxacin, cotrimoxazole, ceftriaxone, gentamicin and amikacin.
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