Encephalopathy With Guillain-Barré Syndrome Secondary to Extensively Multidrug-Resistant Salmonella Typhi Infection: A Case Report.

Salmonella enterica serotype Typhi (S. Typhi) primarily causes typhoid fever but can rarely lead to severe neurological complications. We report a 16-month-old boy who developed encephalopathy with Guillain-Barré Syndrome (GBS) following extensively drug-resistant (XDR) S. Typhi infection after travel to Pakistan. Initially presenting with diarrhea and low-grade fever, he was treated with oral cefixime, but deteriorated with high-grade fever. Blood cultures revealed XDR S. Typhi resistant to multiple antibiotics and sensitive only to meropenem and azithromycin. On admission, he became drowsy and experienced a seizure; lumbar puncture was unremarkable. High-dose dexamethasone was initiated for encephalopathy. He subsequently developed flaccid limb weakness and autonomic dysfunction, and nerve conduction studies confirmed axonal polyneuropathy consistent with GBS. Intravenous immunoglobulin (IVIG) was administered alongside supportive care, and a 21-day course of IV meropenem plus oral azithromycin was completed. The patient gradually regained motor function, and three months post-discharge, he was walking independently. This case illustrates a rare combination of encephalopathy and GBS due to XDR S. Typhi in a pediatric patient, highlighting the importance of early recognition, appropriate antimicrobial therapy, corticosteroids, and IVIG. Clinicians should remain vigilant for neurological complications in children from endemic regions, emphasizing timely diagnosis, tailored therapy, and preventive strategies.