Enteric Encephalopathy: An Old Archenemy

Typhoid fever is the name given to the illness caused by the bacterium Salmonella Typhi, a member of the Salmonella family. Typhoid fever is spread through food and water contaminated by animal and human feces. Typhoid fever is very rare in the United States and other developed nations, and it is more common in underdeveloped nations, particularly Latin America, Asia, and Africa. Typhoid fever has a wide variety of presentations that range from an overwhelming multisystemic illness to relatively minor cases of diarrhea with low-grade fever. The classic presentation is fever, malaise, diffuse abdominal pain, and constipation. Untreated typhoid fever may progress to delirium, obtundation, intestinal hemorrhage, bowel perforation, and death within 1 month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications. Here, we present a 30 years old nurse who presented with fever, constipation and diagnosed as typhoid fever. While on treatment, she developed abnormal behavior. CSF was sterile. Neuro imaging was normal. Considering typhoid encephalopathy she was treated with high dose pulse steroid. She showed significant improvement. Thus, all clinicians should keep in mind the possibility of typhoid encephalopathy as a rare complication of typhoid fever.