# The Many Faces of Enteric Fever: A Case Report on Septic Shock With Tachyarrhythmias, Icterus With Isolated Thrombocytopenia, and Enterocolitis With Leukopenia

## TL;DR

This case report highlights unusual presentations of enteric fever, emphasizing the importance of early diagnosis and targeted treatment for better outcomes.

## Contribution

The paper presents three atypical clinical cases of enteric fever with uncommon complications, offering insights for clinicians in endemic regions.

## Key findings

- Enteric fever can present with septic shock and tachyarrhythmias, requiring chemical cardioversion for management.
- Icterus with isolated thrombocytopenia can be a rare manifestation of Salmonella Typhi infection.
- Enterocolitis with leukopenia in patients with comorbidities may respond poorly to empirical therapy but improve with targeted antibiotics.

## Abstract

Enteric fever is a serious systemic infection that collectively encompasses typhoid and paratyphoid fevers, caused by Salmonella enterica serovars Typhi and Paratyphi, respectively. It is a major public health concern worldwide and may present a complex clinical challenge to physicians in endemic regions. We present a report of three cases highlighting atypical presentations and complications of enteric fever. The first case reports on a 55-year-old man who presented with septic shock complicated by sequential tachyarrhythmias, despite a structurally normal heart and normal serum electrolyte levels, requiring chemical cardioversion. An infection by Salmonella Paratyphi B was confirmed by blood and stool cultures. Subsequent targeted antimicrobial therapy resulted in complete clearance of the infection. Our second case recounts the clinical course of a 25-year-old male patient who presented with sustained fever, icterus, and severe thrombocytopenia. The tropical fever serology panel was noncontributory, but blood culture confirmed Salmonella Typhi infection. Targeted therapy with intravenous ceftriaxone led to complete recovery. The third case presents a 64-year-old female patient with diabetes and hypertension, who presented with an acute abdomen associated with septic shock. Abdominal imaging was performed, which suggested enterocolitis. Empirical antibiotic therapy was met with a modest response, but her clinical course was complicated by worsening leukopenia. The isolation of Salmonella Paratyphi B on blood culture allowed the timely optimization of antibiotic therapy, leading to immune reconstitution and, ultimately, complete clinical recovery. The present report on enteric fever aims to highlight its wide spectrum and uncommon complications observed during its course. Treating clinicians will benefit from maintaining a high index of suspicion for unusual presenting features and culture-guided therapy, especially in endemic regions, to optimize and expedite clinical outcomes.