S5169 The Silent Assault: How Salmonella Can Trigger Acute Liver Injury

Introduction: Nontyphoidal salmonella is a leading cause of gastroenteritis often occurring as a foodborne illness leading to liver injury with possible organ failure. We present a patient with transaminitis found to be secondary to salmonella. Case Description/Methods: A healthy 37-year-old woman presented to the hospital with epigastric pain with radiation to her back and diarrhea for a week. She returned from Fiji but denied any alarming features, abnormal foods, or activities that could have caused her symptoms. She denied any history of hepatitis or malignancy. She denied prior colonoscopy but had a esophagogastroduodenoscopy 10 years ago when she had a cholecystectomy. On admission she was hemodynamically stable. Labs were remarkable for aspartate aminotransferase (AST) 566 U/L, alanine aminotransferase (ALT) 281 U/L, alkaline phosphatase 152 U/L, bilirubin 0.7 mg/dL, and lipase 30 U/L. Ultrasound of the gallbladder showed a common bile duct of 11.6 mm with an absent gallbladder while computed tomography (CT) of the abdomen and pelvis was unremarkable. Due to this new onset of acute liver injury, an autoimmune, infectious, and drug induced cause was investigated. The following day, she had worsening transaminase with an ALT 719 U/L and AST 966 U/L. Upon further questioning, the patient denied any new medications, supplements or analgesic usage. Antinuclear antibody, anti-mitochondrial antibody, anti-smooth muscle antibody, and anti-LKM antibody returned back negative. Hepatitis panel was insignificant. Cytomegalovirus, herpesvirus, Epstein-Barr virus, leptospirosis, COVID-19, influenza, and respiratory syncytial virus were negative as well. Ultimately, the gastrointestinal stool panel resulted in positivity for nontyphoidal Salmonella C2 causing the acute liver injury and symptoms. Patient was treated with ceftriaxone with improvement and was discharged with outpatient follow-up. Discussion: It is rare for nontyphoidal Salmonella to incite acute liver injury in immunocompetent individuals.1 Systemic features such as fever and jaundice found in other reports of Salmonella were absent in our case.2 Acute liver injury in a immunocompetent patient should include ruling out Salmonella as early treatment can improve outcomes. References 1. Bierowski MJ, Edirisuriya CD, Goldberg IP, et al. Nontyphoidal Salmonella Hepatitis: A Rare Complication of a Common Enteric Infection. ACG Case Rep J. 2024;11(9):e01512. 2. Karoli R, Fatima J, Chandra A, Singh G. Salmonella hepatitis: an uncommon complication of a common disease. Journal of Family Medicine and Primary Care. 2012;1(2):160.