Fluoroquinolone-resistant Salmonella typhi causing mirizzi syndrome and cholangitis: A case report

Rationale: The emergence of fluoroquinolone-resistant Salmonella enterica serovar Typhi has become increasingly prevalent across South Asia, Southeast Asia, and sub-Saharan Africa, with resistance rates exceeding 90% in some regions. Hepatobiliary complications, particularly cholangitis and Mirizzi syndrome, are rare manifestations. Patient concerns: A 13-year-old male developed high-grade fever, progressive jaundice, upper abdominal pain, and multiple episodes of non-bilious vomiting for 8 days. Diagnosis: Fluoroquinolone-resistant Salmonella typhi complicated with acute gangrenous cholecystitis, Mirizzi syndrome and cholangitis. Treatment: Emergency cholecystectomy and subsequent endoscopic retrograde cholangiography with biliary drainage were performed. Blood and bile cultures isolated a fluoroquinolone-resistant Salmonella enterica subspecies enterica serovar Typhi . The patient responded to intravenous ceftriaxone. Outcomes: The patient was discharged after 9 days of admission, and the common bile duct stent was removed after 8 weeks following discharge. Lessons: This case emphasizes the critical importance of culture-based diagnosis over serological testing in endemic areas and a multidisciplinary approach in complicated invasive salmonellosis.