SHM Converge Scientific Abstract ePoster Gallery-Murine Typhus in My Tylenol Intoxication: A Case of Murine Typhus Admitted as Acute Acetaminophen Toxicity

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This case report describes a 27-year-old man in south Texas who was admitted for presumed acetaminophen (Tylenol) intoxication after presenting with jaundice and elevated liver enzymes. He had a history of mildly excessive acetaminophen use during a two-week febrile illness marked by myalgias, and he was initially started on N-acetylcysteine (NAC). However, his acetaminophen level was negative, liver tests did not improve with NAC, and further history suggested an atypical infectious process rather than isolated drug toxicity.<br /><br />On exam, he had scleral icterus and splenomegaly but no rash. Laboratory findings included AST/ALT 237/232 and total bilirubin 2.9. Because of the persistent unexplained febrile illness and lack of response to standard treatment, clinicians broadened the differential to include drug-induced liver injury and atypical infection. Serologic testing confirmed murine typhus, with Rickettsia typhi IgM titer of 1:1024.<br /><br />The report emphasizes that murine typhus is endemic in south Texas and can be difficult to diagnose because symptoms are often nonspecific, including fever, malaise, headache, and body aches. Rash is present in only about half of cases, and jaundice or hepatic involvement occurs in a minority. Diagnosis is typically confirmed by a four-fold rise in antibody titers, though high IgM titers can support acute infection. Standard treatment is a 7-day course of doxycycline.<br /><br />The key lesson is that diagnostic anchoring on the patient’s acetaminophen use delayed recognition of murine typhus. Earlier consideration of infectious causes may have prevented unnecessary hospitalization and prolonged treatment.

Asset Subtitle

Angel Padilla

Meta Tag

Author List Angel Padilla, John M. Cunningham

Category Clinical Vignettes

Concept Murine Typhus

Concept Fever

Concept Fourfold Rise in Titer

Concept Doxycycline

Concept Rickettsia typhi

Distinguished Non-Finalist

Presenter Organization University of Texas Health Science Center at San Antonio Joe R. And Teresa Lozano Long School of Medicine

Presenting Author Angel Padilla

Track Adult

Keywords

murine typhus

acetaminophen intoxication

jaundice

elevated liver enzymes

south Texas

Rickettsia typhi

N-acetylcysteine

febrile illness

doxycycline

infectious hepatitis

Murine Typhus

Fever

Fourfold Rise in Titer

Doxycycline

Rickettsia typhi