Unusual Presentation of Typhoid Encephalopathy: Case Reports

Abstract Background . Encephalopathy, associated with high mortality and prolonged sequelae, may be caused by Salmonella typhi infection. However, the similarity of symptoms and routine laboratory results with other infections, may hinder prompt diagnosis and treatment. Blood culture, which is the gold standard for typhoid, was not always performed. We presented two cases of typhoid encephalopathy that had been misdiagnosed as viral and TB meningitis. Proper awareness and blood culture in encephalopathy cases played an important part in diagnosing and, thus, treating these cases properly. Case presentation . First case; a 13-year-old Sundanese male came to the hospital with seizure and fever. He was diagnosed with viral meningoencephalitis and treated with Acyclovir for five days. His fever continued and his condition worsened. Blood culture was found positive for S. typhi on day five of hospitalization. Subsequently, he was diagnosed with typhoid encephalopathy, given Ceftriaxone injection, and his condition improved. He recovered completely after six months. Second Case; a 12-year-old Sundanese male came with a decrease of consciousness and intermittent fever. He was diagnosed with tuberculosis meningitis and treated with first line antituberculosis drugs. IgM Salmonella was positive on the second day of hospitalization, and S. typhi was found through blood culture on his 4 th day of hospitalization, leading to the diagnosis of typhoid encephalopathy. His condition improved after four days with ceftriaxone, and he recovered completely on 3 months follow-up. Conclusions . Typhoid encephalopathy should always be considered as the cause of CNS infection in typhoid endemic areas. Blood culture is crucial in diagnosing encephalopathy cases.