Case Report

Reversible Encephalopathy Secondary to Paratyphoid Infection and Concomitant Acute Hepatitis A

Authors: Marc El-Khoury, Hala Naoushi, Raja Sawaya, Elie Aoun, Nabil T. Nassar, Ala I. Sharara

Abstract

Reversible encephalopathy has been described in association with typhoid fever as well as nontyphoidal salmonella infections. A diagnostic dilemma as to the cause of encephalopathy may arise when there is coexistent acute viral hepatitis and suspicion of fulminant liver failure. The authors report a patient who presented with acute icteric hepatitis A infection and a concomitant febrile illness due to Salmonella paratyphi associated with progressive encephalopathy and coma. The young man developed high-grade fever and coma. Concomitant infection with S paratyphi was diagnosed and the patient's encephalopathy resolved rapidly with antibiotic therapy. This is the first report of a putative association of S paratyphi infection and reversible encephalopathy. Salmonella and hepatitis A virus infection are both transmitted via the fecal-oral route, and awareness of this association is important in the management of such patients.


Key Points


* Reversible encephalopathy occurs in association with typhoid fever as well as nontyphoidal salmonella infections.


* The exact cause of this associated diffuse encephalopathy is unclear, but may be due to release of endotoxins.


* Typhoid and nontyphoidal salmonella infection should be considered in all cases of presumed fulminant hepatic failure, especially in endemic areas.

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