Fluoroquinolone-resistantSalmonella typhicausing mirizzi syndrome and cholangitis: A case report

Abstract

Rationale: The emergence of fluoroquinolone-resistant Salmonella enterica serovar Typhi has become increasingly prevalent across South Asia, Southeast Asia, and sub-Saharan Africa, with resistance rates exceeding 90% in some regions. Hepatobiliary complications, particularly cholangitis and Mirizzi syndrome, are rare manifestations.

Patient concerns: A 13-year-old male developed high-grade fever, progressive jaundice, upper abdominal pain, and multiple episodes of non-bilious vomiting for 8 days.

Diagnosis: Fluoroquinolone-resistant Salmonella typhi complicated with acute gangrenous cholecystitis, Mirizzi syndrome and cholangitis.

Treatment: Emergency cholecystectomy and subsequent endoscopic retrograde cholangiography with biliary drainage were performed. Blood and bile cultures isolated a fluoroquinolone-resistant Salmonella enterica subspecies enterica serovar Typhi. The patient responded to intravenous ceftriaxone.

Outcomes: The patient was discharged after 9 days of admission, and the common bile duct stent was removed after 8 weeks following discharge.

Lessons: This case emphasizes the critical importance of culture-based diagnosis over serological testing in endemic areas and a multidisciplinary approach in complicated invasive salmonellosis.

Keywords

Fluoroquinolone resistance / Mirizzi syndrome / Cholangitis

Conflict of interest statement

The authors declare that they have no conflict of interest.

Ethical approval and consent for publication

Ethics approval was exempt for single-case reports as per SIMS Hospital Institutional Ethics Committee. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Funding

The authors received no extramural funding for the study.

Authors’ contributions

RS conceived the study, designed the manuscript framework, defined the intellectual content, performed literature retrieval, collected clinical data, drafted the original manuscript and revised the manuscript. BR conducted manuscript review. ABR and SSG participated in data acquisition. All authors read and approved the final version of the manuscript.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Pan Y, Lei Y, Zhang Q

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