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Abstract：
Salmonella typhi (S. typhi) infections typically present with fever and gastrointestinal symptoms. This case report on S. typhi enteritis documents atypical clinical, radiological, and endoscopic findings raising diagnostic challenges. A 31-year-old male in the Kingdom of Saudi Arabia (KSA) presented with severe abdominal pain, vomiting, bloody diarrhea, and no fever. Initial diagnosis included amebiasis and other gastroenteritis infections. Despite treatment with ciprofloxacin and metronidazole, the patient\'s condition did not improve, and he kept having intractable abdominal pain and vomiting. Subsequent investigations, including abdominal ultrasound and esophagogastroduodenoscopy, revealed extensive and rapidly progressive intestinal inflammation with wall thickening and ascites. Stool culture eventually identified a multidrug-resistant strain of S. typhi, sensitive only to ceftriaxone. Treatment with ceftriaxone and continuous infusion of proton pump inhibitor (PPI) led to significant improvement. The absence of fever in the context of bloody diarrhea, and the rapid development of ascites not improving with first-line treatment of gastroenteritis, led to the search for other diagnoses such as inflammatory bowel syndromes or tuberculosis. The presentation of diffuse intestinal wall thickening with intractable vomiting, bloody diarrhea, and progressively increasing ascites is not frequently encountered with S. typhi. The case also underscores the growing concern of antibiotic-resistant S. typhi strains. The patient\'s response to targeted antibiotic therapy emphasizes the importance of accurate microbial identification and susceptibility testing in managing infectious diseases. This case report illustrates an atypical presentation of S. typhi enteritis with progressively increasing ascites and increased intestinal wall thickening. The uncommon complicated clinical picture led to challenges in diagnosis and management. It emphasizes the need for high clinical suspicion and comprehensive diagnostic approaches in atypical cases of common infections, especially in the context of increasing antibiotic resistance.
摘要：
伤寒沙门氏菌（S.伤寒）感染通常伴有发烧和胃肠道症状。此例伤寒沙门氏菌肠炎的报告记录了不典型的临床，放射学,和内窥镜检查结果提出了诊断挑战。沙特阿拉伯王国（KSA）一名31岁的男性出现严重的腹痛，呕吐,血性腹泻,没有发烧。最初诊断包括阿米巴病和其他胃肠炎感染。尽管用环丙沙星和甲硝唑治疗，病人的情况没有好转，他一直有顽固性腹痛和呕吐。随后的调查，包括腹部超声和食管胃十二指肠镜检查，显示广泛和快速进展的肠道炎症，壁增厚和腹水。粪便培养最终鉴定出一种多重耐药的伤寒沙门氏菌，只对头孢曲松敏感.头孢曲松治疗和持续输注质子泵抑制剂（PPI）导致显着改善。在血性腹泻的情况下没有发烧，和腹水的快速发展没有改善与胃肠炎的一线治疗，导致寻找其他诊断，如炎症性肠综合征或肺结核。表现为弥漫性肠壁增厚伴顽固性呕吐，血性腹泻,并且逐渐增加的腹水不经常遇到伤寒沙门氏菌。该病例还强调了抗生素抗性伤寒沙门氏菌菌株的日益关注。患者对靶向抗生素治疗的反应强调了准确的微生物鉴定和药敏试验在管理感染性疾病中的重要性。该病例报告说明了伤寒沙门氏菌肠炎的非典型表现，腹水逐渐增加，肠壁增厚增加。罕见的复杂临床表现导致诊断和管理方面的挑战。它强调在常见感染的非典型病例中需要高度临床怀疑和全面的诊断方法，特别是在抗生素耐药性增加的情况下。
