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Salmonella typhi infection mainly causes digestive system symptoms, such as high fever, general muscle and joint pain, abdominal pain, diarrhea and other symptoms.
It can often be cured with antibiotics and symptomatic treatment. However, a severe Salmonella typhi infection can be life-threatening. Today I bring you a related case. Take a look!
Case presentation
Major medical history
The patient, a 63-year-old female patient, was admitted to the hospital with “fever and intercostal pain for 20 days”.
The patient developed fever 20 days ago, with a maximum body temperature of 38°C, showing relaxation fever. Later, the patient developed local pain in the 6th intercostal space of the left midclavicular line and the 5th intercostal space of the right anterior axillary line. Elevated and aggravated, no respiratory tract, digestive tract and other discomfort, no rash.
Outside inspection
leukocytes 7.50×109/L, neutrophils 4.41×109/L, eosinophils 0.01×109/L, calcitonin 0.193ng/ml, high-sensitivity C-reactive protein (sCRP) 12.29 mg/L.
Chest CT showed: hilar mass.
The local hospital considered: “Upper respiratory tract infection, intercostal neuralgia”, given ceftriaxone treatment for 3 days, and performed 2 intercostal nerve blocks, but There was no significant improvement in fever and intercostal pain.
Examination and Diagnosis
Antibiotics were discontinued after admission, Widal test results: typhoid antibody 1:1280 (normal value
Definite diagnosis: Salmonella typhi infection.
Treatment and Outcomes
Combined with the drug susceptibility results, after 1 week of treatment with cefoperazone/sulbactam, the peak body temperature dropped to 37.5℃, but there was still intercostal pain. Repeated chest CT scan, considering the pseudoaneurysm of the descending aorta, compression of the intercostal nerve.
Enhanced aortic CT revealed a perforating ulcer of the descending aorta with pseudoaneurysm formation, and multiple abdominal aortic ulcers (Figure 1). The patient was advised to control the infection before elective surgery.
Patient died from a ruptured aneurysm on the way home.
Fig. 1 enhanced CT revascularization of the aorta shows pseudoaneurysm formation
Case analysis
In this patient, Salmonella infection can cause aneurysm, but died due to untimely treatment.
Therefore, early diagnosis and treatment of infection and aneurysm is especially important. The study found that old age, male, immunosuppression, hypertension, and diabetes are risk factors for its occurrence, and attention should be paid to screening for the occurrence of aneurysm during the course of the disease.
Where can I learn more emergency knowledge?
A patient was admitted on duty in the emergency department, and finding the cause is the most important! How to deal with emergencies correctly?
Severe allergic reaction rescue, is epinephrine the first choice? How is the drug administered? Where can I see the flow chart of the emergency meeting, the main points of treatment, and the most complete summary of emergency medicines?