A young man with fever and hip pain.

A 30 year old man presented with fever since 4 weeks. He was treated in another hospital for enteric fever. Salmonella typhi and coagulase negative staphylococci were isolated from blood cultures drawn at the previous admission. However fever had relapsed after a course of antibiotics. The patient reported left hip pain at admission which had developed over the past 1 day and which grew worse over the hospital stay. Blood counts, liver function tests and serum creatinine were within normal limits. Blood cultures drawn at current admission were negative. An MRI of the left hip was suspicious (sic) for arthritis. An arthrotomy of the involved hip joint was performed. S. typhi was obtained from synovial fluid cultures taken intraoperatively.

The patient was started on intravenous ceftriaxone for 2 weeks followed by oral cotrimoxazole for 4 weeks. The patient's symptoms resolved and he made an uneventful recovery

Enteric fever complicated by left hip joint arthritis

A young woman with acute respiratory distress syndrome

A 23 year old woman presented with fever, abdominal discomfort and few episodes of diarrhea since 4 days. She was seen in the emergency department after developing shortness of breath at rest over a period of few hours. She did not report cough, hemoptysis, gastointestinal bleeding, skin rash or urinary symptoms. At admission, hypoxemia and tachypnea were noted with diffuse symmetrical bilateral pulmonary infiltrates, necessitating endotracheal intubation and mechanical ventilation. Investigatons revealed leucopenia, a normal platelet count and mild transaminitis. Salmonella typhi was isolated from blood cultures drawn at admission. Serolgical tests for dengue and scrub typhus were negative.

The patient was administered intravenous ceftriaxone. The patient was extubated on day 4 of ICU stay and was discharged from the hospital after 8 days.

Enteric fever complicated by Acute Respiratory Distress Syndrome