Prompt recognition and initiation of appropriate antimicrobial therapy can lead to rapid improvement and cure of patients with this potentially deadly infection. His rapid improvement with initiation of antibiotics alone support this theory.Ĭonclusions: Clinicians should keep Salmonella hepatitis in their differential diagnosis when caring for patients who present with acute liver injury and signs of infection or bacteremia. a newborn with elevated bilirubin levels usually is good in the majority of.
#Positive scleral icterus skin#
While the exact cause of his bacteremia remains unclear, our working diagnosis was biliary colic with possible salmonella colonization of the gallbladder. of high bilirubin levels in newborns are skin and/or scleral jaundice. In general the diagnosis is made by positive culture for Salmonella while excluding other possible causes of liver injury. In our patient, alcohol abuse may have contributed to the severity of liver dysfunction. Delay in seeking medical treatment and prior hepatic insults are potential risk factors. Salmonella hepatitis can be a fatal if not recognized and treated early.
The patient was thus diagnosed with Salmonella hepatitis and discharged home on Fluoroquinolone treatment.ĭiscussion: Blood stream infections with Salmonella can be very serious and often associated with systemic manifestations. Blood cultures were found to be positive for Salmonella. On the second day of his hospital stay, his liver functions improved significantly. HIDA scan demonstrated no evidence of acute cholecystitis and MRCP was unremarkable. Abdominal Sonogram demonstrated hepatic steatosis without cholelithiasis or common bile duct dilation. An intravenous antibiotic regimen of ceftrioxone and metronidazole was initiated. Blood cultures, Abdominal Sonogram and a HIDA Scan were performed. Laboratory results were significant for leukocytosis of 17.3 K/uL, total bilirubin of 13.1 mg/dL, direct bilirubin of 7.7 mg/dL and elevated AST/ALT of 248u/L /428u/L respectively. Vital signs were stable and physical exam was remarkable for scleral icterus, jaundice, and right upper quadrant tenderness to palpation without rigidity. His social history was positive for recent travel to the Dominican Republic one week prior. He also reported fever, anorexia and dark orange urine. The patient stated that 3 days prior to presentation, he awoke with severe intermittent right upper quadrant abdominal pain associated with a yellow discoloration of his skin and sclera. Case Presentation: A 37 year-old man with a history of alcohol abuse presented to the emergency department with a chief complaint of abdominal pain and jaundice.
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