title: Reversible encephalopathy secondary to paratyphoid infection and concomitant acute Hepatitis A.
abstract: Reversible encephalopathy has been described in association with typhoid fever as well as nontyphoidal salmonella infections. A diagnostic dilemma as to the cause of encephalopathy may arise when there is coexistent acute viral hepatitis and suspicion of fulminant liver failure. The authors report a patient who presented with acute icteric hepatitis A infection and a concomitant febrile illness due to Salmonella paratyphi associated with progressive encephalopathy and coma. The young man developed high-grade fever and coma. Concomitant infection with S. paratyphi was diagnosed and the patient's encephalopathy resolved rapidly with antibiotic therapy. This is the first report of a putative association of S. paratyphi infection and reversible encephalopathy. Salmonella and hepatitis A virus infection are both transmitted via the fecal-oral route, and awareness of this association is important in the management of such patients.
authors.affiliation: Department of Internal Medicine, Divisions of Infectious Diseases, Neurology and Gastroenterology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Marc
authors.initials: M
authors.lastname: El-Khoury
authors.forename: Hala
authors.initials: H
authors.lastname: Naoushi
authors.forename: Raja
authors.initials: R
authors.lastname: Sawaya
authors.forename: Elie
authors.initials: E
authors.lastname: Aoun
authors.forename: Nabil T
authors.initials: NT
authors.lastname: Nassar
authors.forename: Ala I
authors.initials: AI
authors.lastname: Sharara
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003128:Coma; D006501:Hepatic Encephalopathy / Q000188:drug therapy / Q000209:etiology*; D006506:Hepatitis A / Q000150:complications* / Q000201:enzymology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010284:Paratyphoid Fever / Q000150:complications* / Q000503:physiopathology; D012484:Salmonella paratyphi B / Q000302:isolation & purification* / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents