A Superinfection of Salmonella typhi and Hepatitis E Virus Causes Biphasic Acute Hepatitis |
| |
| Authors: | Takeshi Suda Ryo Iguchi Takaaki Ishiyama Tsutomu Kanefuji Takahiro Hoshi Satoshi Abe Shinichi Morita Kazuyoshi Yagi |
| |
| Affiliation: | 1.Department of Gastroenterology and Hepatology, Uonuma Institute of Community Medicine, Niigata University Medical & Dental Hospital, Japan; 2.Division of General Internal Medicine, National Hospital Organization Shizuoka Medical Center, Japan; 3.Department of Internal Medicine, Hospital Medicine Section, St. Louis University, USA; 4.Department of Gastroenterology and Hepatology, Tsubame Rosai Hospital, Japan |
| |
| Abstract: | A 47-year-old Japanese man was referred to our hospital because of a sustained high fever with diarrhea 12 days after a flight from India. Liver enzymes were elevated with rose spots, hepatosplenomegaly, relative bradycardia, and acute cholecystitis. A liver biopsy depicted the dense infiltration of lymphocytes and Kupffer cells in sinusoids and the granulomatous formation in the parenchyma. The liver damage was initially resolved with the administration of ceftriaxone for 16 days but flared up 1 week later. Laboratory tests yielded positive reactions for Salmonella typhi and hepatitis E virus RNA. The pathophysiological presentations of concurrent typhoid and type E hepatitis are discussed. |
| |
| Keywords: | typhoid hepatitis hepatitis E coinfection ALT/LDH ratio acute cholecystitis |
|
|
