International Journal of Scientific and Research Publications, Volume 4, Issue 12, December 2014 1 ISSN 2250!15! An uncommon presentation of enteric fever: Cholestatic Hepatitis Dr. Anju Dinkar, MD * , Dr. Jitendra Sinh MD ** , Dr. !! "upta, MD *** , Dr. Saura#h !umar **** " Senior Resident, De#artment of $icrobiolo%& , S'P'I$S, (uc)no* "" Senior Resident, De#artment of $edicine, +in% 'eor%es $edica l -ni.ersit&, (uc)no* "" /ssistant Professor, De#artment of $edicine, +in% 'eor%es $edical -ni.ersit&, (uc)no* "" Junior Resident, De#artment of Radiodia%nosis, +in% 'eor%es $edical -ni.ersit&, (uc)no* Abstract$ nteric fe.er or t&#hoid3 is a common infectious di seaseIt is a common cause of morbidit & and hos#ital admission in de.elo#in% countries li)e Indiae re#ort a case of6holestatic 7e#atitis secondar& to enteric fe.er in a 42&earold male *ho *as admitted to our medical emer%enc& unit *ith chiefcom#laints of fe.er for 8 da&s follo*ed b& anore9ia, abdominal disc omfo rt and :aun dice7e reco .ere d com# lete l& to #rom# t administration of a##ro#riate antibiotic thera#& *ith su##orti.e mana%ementIndex Te rmsnt eric e .er, salmonella, 6holestatic :aundice, Icterus, salmonella he#atitis II N;R<D-6;I<N nteric e.er is a s&stemic disease characteri=ed b& fe.er, abdominal #ain and caused b& dissemination of S. typhi orS. paratyphi*hich is #atholo%icall& as a uni>ue illness because of its association *ith enlar%ed Pe&er?s #atches and mesenteric l&m#h nodes @1A ;he 'ast roint esti nal com#l icat ions of are int est ina l hae mor rha %e and #er for ati on, acute #an cre ati tis , he#atic abscess, acute cholec&stitis, s#lenic ru#ture and he#atitis@2A (i.er tests su%%estin% cholestatic disorder ma& be due to intraor e9trahe#atic cholestasisis )no*n to cause a *ide ran%e ofhe#atic com#lications@!A 7o*e.er, onl& fe* cases of cholestatic he#atitis secondar& to are re#orted in literature@4,5A II6/SRP<R; / 45 &ears old male, office *or)er, resident of luc)no* *as #resented in our emer%e nc& de#artment *ith chief com#laints ofanore9ia, and hi%h %rade fe.er for 12 da&s follo*ed b& a .a%ue ri %ht h& #ochondr ia l di scomfort , .omi ti n% and &e ll o*is h discolouration of e&es for 4 da&s<n en>uir& he told that he had al so cons ti #a ti on associ at ed *i th da r) ur ine7e de ni ed com#laint of #ruritus7e had no histor& of :aundice, alcoholism, con tac t his tor & *it h mudd& *at er and blo od transf usi ons, #romiscuit& or intra.enous dru% abuse and si%nificant #ast medical histor&<n %ene ral e9aminat ion #ati ent *as conscious and *ell oriented7e had icterus7e had no #allor or l&m#hadeno#ath&7e *as feb ril e 10 !B3 and his #ul se rate *as 80C min and re%u lar , P11 0CE0mm7% and res# irat or& rate *as18CminS&stemic e9amination re.ealed tender firm mild he#atome%al& and %a ll bl adder *a s not #al#able Re st of the s&stemic e9aminations *ere *ithin normal limitIn.esti%ations of #atient durin% hos#italisation are summarised in table 16om#uteri=ed tomo%r a#h& 6;3 of abdome n sho*ed mil d he# ato me% al& 15Ecm3 *ith normal mar%ins and normal 6; attenuation .alueNo e.idence of an& intrahe#ati c biliar& radical dilatation I 7RD3 not ed'all bla dde r is not ed to be dis ten ded *ith norma l in 6; attenua tion .alue *ith normal *all thic )enin %@i% ure1A (i.e r bio#s & sho*ed he#a tic chol esta sis @i% ure2 An=&melin)ed immunosorbent assa& for human immunodeficienc& .irus, /ustralia anti%en for 7e#atitis and antibod& a%ainst 7e#atitis 6 .irus *ere ne%ati.eSerolo%& I%$ ant ibo d&3 for den%ue inf ect ion and sme ar e9a min ati on formalarial #arasite *ere ne%ati.electrocardio%ra#h& and chest Fra& *ere *ithin normal limit7is blood culture *as sterile and serolo%& I%$ antibod&3forSalmonella typhi *as #ositi.e<urcas e *as alr ead & on ora l ant ibi oti c at the ti me of admiss ion *hich could be a reason for sterile blood culture;he dia%nosis of cholestatic he#atitis due to enteric fe.er*as made on the basis of clinical and laborator& #arameters *ith #ositi.e serolo%& I%$ antibod&3 forSal mon ell a typ hi. Soceft ria9o ne !%m #er da& intra.enous *as st arte d for 10 da&sPa ti ent *a s st ar te d im#r o.in% da& b& da & and %ot di sc ha r% ed on 12 th da & of admis sion(i.er funct ion test sho*ed near normali= atio n on follo* u# after 2 *ee)s of admissionIIIDIS6-SSI<Nnteric fe.er remains a serious health threat in de.elo#in% count ries inclu din% Indi a@GA $ost commonl& , foodborne or*aterborne transmission results from fecal contamination b& ill or as& m#t oma tic chr oni c car ri ers -# to 10H of unt rea ted #atients *ith t&#hoid fe.er e9crete S. typhiin the feces for u# to ! months, and 14H de.elo# chronic as& m#tomatic carria% e, she ddi n% S. typhiin eit her ur ine or sto ol for 1 &e ar *hi ch inc rea ses its #re.a lence and inc ide nce nt eri c fe. er can manifest a .ariet& of s&stemic com#lications ran%in% from mild to lifethreat enin% such as %astrointest inal bleedin% and intesti nal #erforation *hich most commonl& occur in the third and fourth *ee) s of illn ess@1A Rare com# lica tions *hose inci dence s are reduc ed b& #rom# t antibiotic trea tment include diss emina ted intra.ascular coa% ul at ion, he mo#ha% oc& tic s& ndrome , #ancreatitis, he#atic and s#lenic abscesses and %ranulomas, end oca rdi tis , #er ica rdi tis , m&oca rdi tis , orc hit is, he#ati tis , %lo mer ulo ne# hri tis , #&elone# hri tis and hemol& tic ure mic s&ndr ome , se. ere #ne umonia , art hri tis , os teo m&eli tis , and #arotitis@K,EA ;he first case of he#atic in.ol.ement in t&#hoid fe.erwww.ijsrp.org
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An uncommon presentation of enteric fever: Cholestatic Hepatitis
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8/10/2019 An uncommon presentation of enteric fever: Cholestatic Hepatitis
@5A /lba&ra) /, 'unbe& SS, /)tas O 6holestatic he#atitis due to Salmonellat&#hi 6linics and Practice 2011, 1Oe1!
@GA Dutta S, Di#i)a S, &om)esh $, has*ati S, /lo) +umar D, Jac>ueline(D, John , (oren= VS, (eon <, John D6 and Su:it +umar .aluationof ne*%eneration serolo%ic tests for the dia%nosis of t&#hoid fe.erO datafrom a communit&based sur.eillance in 6alcutta, India Dia%nostic$icrobiolo%& and Infectious Disease 200G5G43 !58!G5