SHM Converge Scientific Abstract ePoster Gallery-Not Your Typhi-Cal Case of Psychosis and Rhabdomyolysis

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This case describes a previously healthy, obese 15-year-old boy who presented to the emergency department with six days of headache, fever, and myalgias, followed by one day of diarrhea, cough, and acute hallucinations. He had no travel history, but exposures included a petting zoo, cats, and insect bites. On exam, he was febrile, tachycardic, tachypneic, disoriented, and increasingly psychotic-appearing, with inappropriate laughter and bizarre statements. He also had scattered insect bites and cat scratches.<br /><br />Initial testing showed marked inflammation and rhabdomyolysis, including CK 14,068 U/L, elevated AST/ALT, mild hyperbilirubinemia, and elevated CRP/ESR. Urinalysis showed large blood with few RBCs, consistent with myoglobinuria. CT head and chest X-ray were normal. Abdominal ultrasound showed hepatosplenomegaly. Broad infectious workup was negative, including GI pathogen panel, respiratory viral panel, urine culture, EBV, mononucleosis, RMSF, Bartonella, Ehrlichia, and HIV. Lumbar puncture was not consistent with bacterial meningitis, and CSF studies were negative.<br /><br />Blood cultures grew gram-negative rods, later identified by MALDI-TOF and public health typing as Salmonella enterica serotype typhi. The final diagnosis was typhoid fever with S. typhi bacteremia complicated by acute psychosis and rhabdomyolysis.<br /><br />During hospitalization, his encephalopathy worsened to the point that he required sedation in the pediatric ICU because of severe hallucinations and aggressive behavior. He was treated with IV fluids and appropriate antibiotics, with resolution of both encephalopathy and rhabdomyolysis by discharge.<br /><br />The case highlights that typhoid fever can present in unusual ways, including neuropsychiatric symptoms and rhabdomyolysis, even without travel history and even when stool/GI testing is negative.

Asset Subtitle

Ghallia S. Kaouk

Meta Tag

Author List Daniel Park, Elizabeth M. O'Neil, Emilee C. Lewis, Ghallia S. Kaouk, Kelly Orgel, Logan Patterson, Ria Dancel, Sahal Thahir

Category Clinical Vignettes

Concept Salmonella typhi infection

Concept Neuropsychiatric Symptom

Concept Blood Culture

Concept Rhabdomyolysis

Concept Antibiotic Treatment

Distinguished Non-Finalist

Presenter Organization UNC Hospitals

Presenting Author Ghallia S. Kaouk

Track Pediatric

Keywords

typhoid fever

Salmonella typhi

bacteremia

acute psychosis

hallucinations

rhabdomyolysis

encephalopathy

pediatric ICU

hepatosplenomegaly

myoglobinuria

Salmonella typhi infection

Neuropsychiatric Symptom

Blood Culture

Rhabdomyolysis

Antibiotic Treatment