Typhoid fever presenting with gastric ulcer bleeding

• Published in: BMC gastroenterology 2022-03, Vol.22 (1), p.116-116, Article 116
• Main Authors: Jeon, Hong Jae, Lee, Jong Seo, Lee, Byung Seok, Kim, Seok Hyun, Lee, Eaum Seok, Sung, Jae Kyu, Moon, Hee Seok, Kang, Sun Hyung, Lee, Hyun Seok, Choi, Seongwoo, Sa-Kong, Heon, Cheon, Shinhye, Eun, Hyuk Soo
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Case Report; Complications and side effects; Diagnosis; Dosage and administration; Female; Gastric ulcer; Gastrointestinal bleeding; Gastrointestinal Hemorrhage - etiology; Gastrointestinal hemorrhages; Humans; Nonsteroidal anti-inflammatory drugs; Prevention; Risk factors; Salmonella enterica serovar Typhi; Salmonella paratyphi A; Salmonella typhi; Stomach ulcer; Stomach Ulcer - complications; Stomach Ulcer - diagnosis; Stomach Ulcer - drug therapy; Typhoid fever; Typhoid Fever - complications; Typhoid Fever - diagnosis; Typhoid Fever - drug therapy; Typhoid fevers
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-022-02192-2

Enteric fever is a systemic disease caused by Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi, characterized by high fever and abdominal pain. Most patients with enteric fever improve within a few days after antibiotic treatment. However, some patients do not recover as easily and develop fatal life-threatening complications, including intestinal hemorrhage. Lower gastrointestinal bleeding has been reported in 10% of cases. However, upper gastrointestinal bleeding has rarely been reported in patients with enteric fever. We present a case of gastric ulcer hemorrhage caused by enteric fever. A 32-year-old woman, complaining of fever lasting four days and right upper quadrant pain and melena that started one day before admission, consulted our hospital. Abdominal computed tomography revealed mild hepatomegaly and gastroscopy revealed multiple active gastric ulcers with flat black hemorrhagic spots. The melena of the patient stopped on the third day. On the fifth admission day, she developed hematochezia. At that time, Salmonella enterica serovar Typhi was isolated from the blood culture. The antibiotic regimen was switched to ceftriaxone. Her hematochezia spontaneously resolved the following day. Finally, the patient was discharged on the 12th admission day without clinical symptoms. However, her fever recurred one month after discharge, and she was readmitted and Salmonella enterica serovar Typhi was confirmed again via blood culture. She was treated with ceftriaxone for one month, and was discharged without complications. Our case showed that although rare, active gastric ulcers can develop in patients with enteric fever. Therefore, upper and lower gastrointestinal bleeding should be suspected in patients with enteric fever, especially showing relapsing bacteremia.