Celalettin VATANSEV, Murat GÖLCÜK, Hüseyin YILMAZ, Ahmed PAMUKÇU

Salmonella hepatiti: Tıkanma sarılığı ile karışan iki olgu

Amaç: Hepatit komplikasyonu ile başlayan Salmonellozis olgularına nadiren rastlanır. Sarılık sebebi patolojilerle ve başka nedenlerle oluşan hepatitlerle karışabildiği için tanıda güçlük çekilir. Tıkanma sarılığı ön tanısıyla yatırılan ve karaciğer fonksiyonları ileri derecede etkilenen, biri Salmonella paratyphi B diğeri Salmonella typhi ile oluşan iki salmonella hepatiti olgusunu sunmayı amaçladık. Olgu sunumu: Olguların her ikisinde de sarılık, ateş, karın ağrısı ve toksemi bulguları vardı. Gruber-Widal testinde titreler, anlamlı olarak yüksekti. Bir olguda kan kültüründe Salmonella typhi izole edildi. Olgular siprofloksasin ve seftriakson ile tedavi edildi. Sonuç: Endemik bölgelerde yüksek ateşle birlikte yüksek bilirubin ve transaminaz değerleri varlığında ayırıcı tanıda salmonella hepatitleri akılda bulundurulmalıdır.

Anahtar Kelimeler:

Salmonella typhi, Salmonella enfeksiyonları, Hepatit, Sarılık, tıkanma, Tanı, ayırıcı, İlaç tedavisi, Orta Yaş

Salmonella hepatitis: Two cases confused with obstructive jaundice

Objective: It is a rare occasion to find Salmonellosis that commence with hepatic complication. Salmonella hepatitis can be confused with other etiologies of jaundice. We aimed to introduce two cases of Salmonella hepatitis who presented with obstructive jaundice in whom liver function tests were extremely abnormal, one of them was salmonella paratyphi B the other was salmonella typhi. Case report: Both of them had jaundice, fever, abdominal pain, and toxemia. The Widal tests were significantly high. Salmonella typhi was isolated in one of them. These cases were treated by ciprofloxacin and ceftriaxone. Conclusion: In endemic areas, the presence of high bilirubin and transaminase values concomitantly with high fever should lead physicians to think of salmonella hepatitis in differential diagnosis.

Keywords:

Salmonella typhi, Salmonella Infections, Hepatitis, Jaundice, Obstructive, Diagnosis, Differential, Drug Therapy, Middle Age,

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1. Butler T. Typhoid fever. Wyngaarden, Smith, Bennett, editors. Cecil Texbook of Medicine, 19th ed. WB Saunders Company Philadelphia 1992. p. 1690
2. Broadhead RL, Sehgal KC. Necrotising enterocolitis associated with Salmonella paratyphi B type 4, 5. Ann Trop Paediatr 1981;1:65-8.
3. Cohen JI, Bartlett JA, Corey GR. Extra-intestinal manifestations of Salmonella infections. Medicine 1987;66:349-88.
4. Lambotte O, Debord T, Castagne C, Roue R. Unusual presentation of typhoid fever: Cutaneous vasculitis, pancreatitis, and splenic abscess. J Infect 2001;42:161-2.
5. Yildiran A, Siga E, Baykal S, Okten A. Sepsis and multiple brain abscesses caused by Salmonella paratyphi B in an infant: Successful treatment with sulbactam-ampicillin and surgical drainage. Turk J Pediatr 2001;43:85-7.
6. Arif N, Khan AA, Iqbal Z. Hepatic involvement with typhoid fever : A report of nine patients. J Pak Med Assoc 1990;40:4-9.
7. Sirmatel F, Balci I, Sirmatel O, Bayazit N, Hocaoglu S. A case of Salmonella paratyphi B septicaemia complicated by disseminated intravascular coagulation, severe hepatitis rhabdomyolysis and acute renal failure. J Infect 2001;43:19.
8. Olubodun JO, Kuti JA, Adefuye BO, Talabi AO. Typhoid fever associated with severe hepatitis. Cent Afr J Med 1994;40:262-4.
9. Mahmood BA. Typhoid hepatitis: two case reports. Bangladesh Med Res Counc Bull 1989;15:12-4.
10. Pandey CK, Singh N, Kumar V, Awargal A, Singh PK. Typhoid, hepatitis E, or typhoid and hepatitis E: The cause of fulminant hepatic failure-a diagnostic dilemma. Crit Care Med 2002;30:376-8.
11. Kumar A, Arora V, Bashamboo A, Ali S. Detection of Salmonella typhi by polymerase chain reaction: Implications in diagnosis of typhoid fever. Infect Genet Evol 2002;2:107-10.
12. Liberti A, Loiacono L. Ciprofloxacin versus chloramphenicol in the treatment of salmonella infection. Int J Antimicrob Agents 2000;16:347-8.