Nonimmune hemolytic anemia as a rare complication of enteric fever

Abstract In endemic areas, Salmonella enterica serovar Typhi -caused enteric fever continues to be a serious health risk. However, potentially life-threatening hemolytic complications are rare in enteric fever. We report the case of a 44-year-old female with 20 days of high-grade fever, severe anemia, and biochemistry suggestive of intravascular hemolysis. Blood culture grew nalidixic acid–resistant Salmonella Typhi . She was successfully treated with intravenous ceftriaxone and supportive transfusion therapy, resulting in a normalization of hemolysis markers and partial recovery of hemoglobin levels by the 15 th day of hospitalization. While hematological abnormalities such as anemia, thrombocytopenia, and leukopenia are frequently encountered in enteric fever, acute nonimmune hemolytic anemia in the absence of enzymatic defects or hemoglobinopathies is exceptionally rare as highlighted in this report. This case highlights the importance of considering infection-related nonimmune hemolysis in prolonged febrile illnesses, even in the absence of classical hematological risk factors.