Salmonella Typhi Abscess Following Liver Biopsy

1Washington University in St. Louis, St. Louis, MO

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 352

Case Presentation:

A 23‐year‐old man with severe chorea and dysarthria due to Wilson's disease presented 5 days after percutaneous liver biopsy with persistent abdominal pain and fever as high as 104°F. He stopped eating and drinking and was unable to walk or speak as usual. Constipation and decreased urine output were noted. CT scan of the abdomen/pelvis revealed a complex fluid collection involving the gallbladder fossa, ascending colon and cecum, as well as ileus. Broad‐spectrum antibiotics, IV fluids, and opiate analgesia were administered. Subsequent MRI revealed a 22 × 8 cm fluid collection in the gallbladder fossa extending to the cecum and surrounding the ascending colon, consistent with abscess possibly from an infected hematoma or bile leak. Radionuclide imaging did not demonstrate a bile leak. The patient developed leukocytosis despite antibiotics, so a percutaneous drain was placed into the large fluid collection; purulent fluid grew Salmonella typhi. The antibiotic was changed to ertapenem based on susceptibilities. The drain was removed after 18 days, when resolution of the fluid collection was demonstrated on CT scan. The patient was able to advance his diet with resolution of ileus. Dystonia was managed with benzodiazepines and diphenhydramine; neurologic status returned to his baseline. Further history revealed that the patient had travelled occasionally to India with his mother, the last time 2 years ago. The mother had developed typhoid fever while travelling but denied that her son was sick with similar symptoms. Further review of medical record revealed that the patient had experienced worsening painful muscle spasms and dystonia over the past year and a half since returning from India. The patient was likely infected during travel to India and became a chronic carrier of Salmonella typhi in his biliary tract; the organism proliferated in the intra‐abdominal fluid collection following traumatic liver biopsy.

Discussion:

Salmonella typhi, the causative agent of typhoid fever, remains endemic in less‐developed areas of the world. Symptoms include fever, chills, diarrhea, myalgia, headache, sore throat, and cough. Infection is rare in the United States, with fewer than 500 cases each year. The gram‐negative rod colonizes the intestinal and biliary tract for long periods. This patient's muscle spasms and dystonia from Wilson's disease were likely worsened by the underlying infection from Salmonella typhi. Symptoms of underlying psychiatric and neurologic disease are often exacerbated by acute illness, and patients may not be able to report typical symptoms.

Conclusions:

This case demonstrates an unusual intra‐abdominal infection with Salmonella typhi as a complication of a liver biopsy, resulting from colonization of the biliary tree in a remote traveler.

To cite this abstract:

Richard L. Salmonella Typhi Abscess Following Liver Biopsy. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 352. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/salmonella-typhi-abscess-following-liver-biopsy/. Accessed July 24, 2019.

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