Rare case unravels uncommon Hematological Complication of typhoid Fever: A report

The case report published in the Journal of the Association of Physicians of India describes the case of a young female who presented with complaints of severe left upper quadrant pain after being diagnosed with typhoid fever.

Computed tomography (CT) showed multiple wedge-shaped splenic infarcts. She was treated with antibiotics and was also started on antiplatelets. She completely recovered with this management, and antiplatelets were tapered off on subsequent visits.

The case is of a 25-year-old female patient with no known comorbidities who was referred to a hospital with complaints of high-grade fever for 9 days, which was associated with loose stools. She was diagnosed with typhoid fever from the referring hospital and was started on ceftriaxone. She then started complaining of chest pain, left-sided abdominal pain, and breathlessness. She had a family history of rheumatoid arthritis in her mother.

On examination, she was oriented and conscious, febrile, and had a temperature of 104°F. Her abdominal examination showed tenderness over the left hypochondrium, and her respiratory system showed signs of left-sided pleural effusion.

She was admitted, and baseline blood investigations were conducted. Her blood culture confirmed the diagnosis of Salmonella Typhi, which was sensitive to the antibiotic. Her serology for other tropical illnesses, such as dengue, malaria, leptospirosis, and scrub typhus, was negative.

On further evaluation, an abdomen ultrasound showed hepatomegaly, mild splenomegaly with an evolving abscess of size 8 × 7 cm. It was followed by contrast-enhanced computed tomography (CBCT) of the chest and abdomen, which revealed multiple wedge-shaped splenic infarcts and mild pleural effusion. The echocardiogram was unremarkable, and the thrombophilia panel was within normal range.

She was treated with antibiotics, nonsteroidal anti-inflammatory drugs, and fluid resuscitation and was put on oral antibiotics on discharge. A rheumatologist and hematologist took an opinion to exclude hypercoagulable states, blood-borne malignancy, autoimmune diseases, and collagen vascular diseases.

She was initiated on antiplatelets and continued for 6 months. Her follow-up ultrasound of the abdomen revealed a normal splenic echotexture and size.

“Splenic infarction is an unusual complication of typhoid fever, and there are only a few literature mentioned for the same,” the researchers wrote. “Common presentation is left-sided abdomen pain and tenderness. CT scan is the imaging modality of choice for suspected patients.”

“It is also crucial to exclude other common causes of splenic infarction. We have found a benefit with antiplatelet therapy and supportive treatment in our patient,” they concluded.

Reference:

John S, V A. An Unusual Hematological Complication of Typhoid Fever Case Report. J Assoc Physicians India 2024;72(5):101-102.