Typhoid fever presenting as neuropsychiatric oddities: A case report

Abstract

Rationale: Salmonella is a common etiological agent behind the tropical fever syndrome in the Indian subcontinent. Its prevalence in India remains high due to a lack of proper sanitation services in large parts of the country. Its neuropsychiatric manifestations is rare and the understanding on their pathophysiology is still poor. Patient concerns: A 19-year-old male, presented with a 10-day history of altered mental status, high-grade fever and violent behaviour. 2 Days prior to admission, he developed decreased responsiveness and a muttering delirium with self-talking. Diagnosis: Coma vigil secondary to salmonellosis. Interventions: Intravenous ceftriaxone and dexamethasone. Outcomes: The resolution of the coma vigil and the associated Salmonella infection were observed; however, the patient developed residual mutism. Lessons: The atypical presentation of a globally obtunded state followed by mutism in typhoid coma in this case should be brought to the attention of clinicians worldwide. Additionally, the enduring speech limitations and potential psychiatric consequences may be linked to the prolonged duration of the infection.