S5129 Nontyphoid Salmonella-Associated Hepatitis: A Rare Infectious Case

Introduction: Non-typhoidal Salmonella (NTS) is a common bacterial pathogen typically causing self-limited gastroenteritis. Extraintestinal manifestations, such as hepatitis, are rare and usually occur in immunocompromised individuals. We report a case of NTS-induced hepatitis in an immunocompetent 32-year-old man. Case Description/Methods: The patient, previously healthy, presented with fever, abdominal pain, diarrhea, and vomiting. Physical examination revealed right upper quadrant tenderness and a small erythematous chest rash. Laboratory results showed elevated liver enzymes (aspartate aminotransferase 807 IU/L, alanine aminotransferase 761 IU/L), leukopenia, and international normalized ratio (INR) 1.27. A viral hepatitis panel, cytomegalovirus, herpes simplex virus, varicella, and other relevant tests were negative, except for past Epstein-Barr virus exposure. Stool studies identified Salmonella and enteroaggregative Escherichia coli, and blood cultures grew Salmonella and Enterobacterales. Imaging, including right upper quadrant ultrasound and computerized tomography (CT) of the abdomen and pelvis, showed no significant findings. The patient was diagnosed with sepsis secondary to Salmonella hepatitis and was treated with intravenous ceftriaxone 2 g for 4 days. His liver enzymes improved, and he was discharged on oral cefdinir 300 mg twice daily for a 7-day course. Discussion: Salmonella is a Gram-negative bacterium primarily transmitted through contaminated food, particularly undercooked meat, eggs, and produce. While typically causing gastroenteritis, Salmonella can rarely lead to extraintestinal manifestations, including hepatitis, often in patients with underlying liver disease or immunosuppression. The pathophysiology of Salmonella-induced hepatitis is not fully understood but is thought to involve direct bacterial invasion and inflammatory responses triggered by endotoxin release. The source of the patient’s infection was unclear. A recent cucumber-related outbreak was ongoing, although the patient disliked cucumbers, his family incorporated them into meals but no other family members were symptomatic. The patient had a pet chihuahua but no contact with farm animals or turtles, and no recent international travel. This case highlights the rare occurrence of Salmonella-induced hepatitis in an immunocompetent individual and underscores the need for consideration of extraintestinal manifestations in severe Salmonella infections.