Salmonella typhi infection complicated by rhabdomyolysis, pancreatitis and polyneuropathy.

INTRODUCTION

Typhoid is a common infection that can have serious complications. Here we present a severe case of Salmonella typhi infection complicated by rhabdomyolysis and acute kidney injury.

CASE REPORT: A 42-year-old male presented with shortness of breath, generalized body aches and upper abdominal pain two weeks after returning from India. Investigations revealed severe metabolic acidosis (arterial blood pH 6.9), high serum creatinine (12.7 mg/dl), hyperuricemia (16.4 mg/dl), hypocalcemia (4.1 mg/dl), hyperphosphatemia (16.1 mg/dl), high serum amylase (1458 u/L), thrombocytopenia (59,000/mm3) and disturbed coagulation profile. The diagnosis of rhabdomyolysis was confirmed by an elevated creatine phosphokinase level of 17,000 U/L. The patient was started on hemodialysis, and two days later he developed broncho-pneumonia and required mechanical ventilation. Blood cultures grew Salmonella typhi; parenteral imipenem-cilastin and ciprofloxacin were initiated. After one week, the patient continued to have fever despite improvement of biochemical parameters and negative blood and stool cultures. Antibiotic drug-fever was suspected and antibiotics were stopped. Subsequently, fever and rash disappeared and the patient was switched to ceftazidime two days later. The patient eventually regained normal kidney function but continued to have weakness in both lower limbs. Electromyography (EMG) and nerve conduction studies revealed diffuse axonal sensorimotor polyneuropathy that progressively improved over time.

CONCLUSION

Common infective agents, including salmonella typhi, can present in unusual ways. The possibility of a severe systemic infection being the underlying cause of rhabdomyolysis should not be overlooked.

KEYWORDS: Acute Kidney Injury; Neuropathy; Rhabdomyolysis; Salmonellosis; Typhoid.