Intractable Hiccups as the Presenting Symptom of Relapsed Salmonella Bacteremia Complicated by Salmonella Endocarditis

Salmonella infections are generally acute diarrheal illnesses that uncommonly spread to deeper or endovascular tissues, with key symptoms being nausea, vomiting, diarrhea, abdominal pain and fever. We present a case of a 76-year male who presented chiefly with recurrent intractable hiccups after finishing two weeks of oral ciprofloxacin for a previous episode of Salmonella bacteremia. He was ultimately found to have an aortic root vegetation on transesophageal echocardiogram and focal adenomyomatosis on gallbladder ultrasound. He underwent cholecystectomy, aortic valve replacement and six weeks of antibiotic therapy with resolution of his hiccups. Our case demonstrates an atypical symptom of intractable hiccups (one that is usually not of great medical relevance in such cases) of an uncommon illness that can be life-threatening if diagnosis is delayed or complications set in. A high degree of suspicion for gastrointestinal source must be suspected when dealing with Salmonella infections and cholecystectomy should be considered for patients with recurrent symptoms or with Salmonella bacteremia.