Spectrum of enteric fever complications: As wide as in yesteryears

Abstract

Enteric fever can have wide clinical presentation in humans. We report few rare complications of enteric fever such as secondary hemophagocytic lymphohistiocytosis, liver abscess, encephalopathy, and myopericarditis. Interestingly none of these cases are easy to recognize in early days in far flung remote areas where facilities are lacking. In our observance, first case was of 59-year-old male, who presented with acute febrile illness, thrombocytopenia, and hepatosplenomegaly. The patient had progressive pancytopenia with clinical deterioration. A diagnosis of secondary hemophagocytic lymphohistiocytosis was made and managed. The second case presented as fever with acute abdomen, which was due to pyogenic liver abscess caused by Salmonella typhi (S. typhi). Third case was 65-year-old female who presented with fever associated with neuropschychiatric and cerebeller signs. She was diagnosed as enteric encephalitis and managed with antibiotics along with corticosteroids. Fourth case was of 22-year-old female with blood culture positive for S. typhi and positive serum Widal test who after 3 days of treatment developed sudden cardiogenic shock and echocardiography confirmed presence of myopericarditis with mild pericardial effusion.