Talal Bhatti, MACG1, Muslim Atique, MD2 1SZABMU, PIMS Islamabad, Islamabad, Islamabad, Pakistan; 2Shifa International Hospital, Islamabad, Islamabad, Pakistan
Introduction: We present a case of concomitant cholangitis & liver abscess in a young male with culture (bile fluid) proven Salmonella Typhi in the bile which was sensitive to Meropenem and Vancomycin only. Multiple drug resistant strain of salmonella typhi can often lead to serious complications as we present in our case.
Currently, control of such an unknown outbreak of Salmonella Typhi’s multiple drug resistant strains are crucial, since it is a serious health care issue in disease control and prevention in endemic countries.
Case Description/Methods: A 28 year old male of Asian ethnicity with no comorbid, presented with history of 1.5 months of RUQ pain, intermittent fever and weight loss. He also complained of decreased oral intake associated with vomiting. Patient also gave history of clay color stool associated with jaundice, and dark urine. He denied any hematemesis, shortness of breath, or palmar erythema. Physical examination was unremarkable except hepatomegaly.
Laboratory findings on admission showed a raised TLC OF 40,000 u/dl, platelet count of 566,000, hemoglobin of 8.3, and CRP of 199.4. His liver function tests (LFTs) were deranged as: ALT: 75, AST:122, ALP: 310, GGT: 93, total bilirubin: 9.21 and direct bilirubin:6.75. Blood culture and sensitivity were sent with strong suspicion of cholangitis and patient was started on Meropenem, Vancomycin, PPI and antiemetics.
Patient had multiple high grade fever spikes even during hospitalization. Computerized tomography (CT) scan was done and showed multiple cystic hypodensities of variable sizes continuing with bile ducts scattered in hepatic parenchyma and mild to moderate intrahepatic biliary dilatation with dilated CBD with an 11.8 mm calculus suggesting choledocholithiasis (Add image of ERCP). Keeping in view the radiological and laboratory findings, an impression of cholangitis with liver abscess was made.
ERCP was planned in same admission and CBD cannulation was done. The stone was visualized on cholangiogram in distal CBD. 10 Fr x 7 cm plastic stent was deployed, while thick bile was aspirated and sent for culture and sensitivity. Quite surprisingly, his bile fluid showed Salmonella Typhi, a rare finding in cases of cholangitis. Diagnosis of Biliary sepsis was made
Discussion: In interest of formulating a healthcare policy in managing such infections, it will remain vital to quantify the infection in patients with biliary disease
Figure: Ercp Image, CT Adomen, of patient of biliary sepsis with Salmonella typhi in Culture
Talal Bhatti indicated no relevant financial relationships.
Muslim Atique indicated no relevant financial relationships.
Talal Bhatti, MACG1, Muslim Atique, MD2. P1514 - An Unusual Cause of Cholangitis by Multiple Drug Resistant Strain of Salmonella typhi: A Case-Based Literature Review, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.