Acute Appendicitis with Concomitant Typhoid Fever: A Case Report

Abstract

Typhoid fever is one of the leading causes of mortality and morbidity in crowded and unhygienic areas. Acute appendicitis is a relatively common cause of acute abdomen, especially in young adults. Infection with Salmonella typhi can be a rare cause of acute appendicitis. A 40-year-old man was admitted to Emergency Department with complaints of fever, abdominal pain, nausea, and vomiting for more than a week. His vital signs were stable. Physical examinations showed hyperactive bowel sounds (borborygmus), tenderness in the right lower quadrant region, and a positive Rovsing sign. The complete blood count and other laboratory results were within normal limits, as the patient had received oral antibiotics while on treatment at another hospital before. IgM anti-S. typhi was positive. Abdominal ultrasound revealed a blind end tube, a non-peristaltic, non-compressible appendix showing a target sign, and fluid collection periappendiceal. The patient underwent appendectomy on the fourth day of treatment, and the pathological examinations revealed that the mucosa was necrotic and that a large number of lymphoid follicles were evident. Typhoid fever may manifest as mesenteric lymphadenopathy, ileocolitis, or even bowel perforation, which mimics appendicitis. Appendicitis is usually caused by appendiceal lumen occlusion. Less frequently, enteric infections could directly infect the appendix or cause localized appendiceal lymphoid hyperplasia with obstruction. It is unclear whether primary appendicular lumen obstruction brought on by lymphoid hyperplasia or direct bacterial invasion of the appendix causes acute appendicitis and typhoid fever. There is no proof that the pathogen directly invades the appendix or that it obstructs it through proliferating lymph nodes. This case might remind clinicians that appendicitis might be a potential but uncommon differential diagnosis for typhoid fever in patients who have persistent abdominal pain, nausea, vomiting, and fever. We suggest performing a culture on appendix tissue in future studies to determine whether the bacteria that cause typhoid fever and acute appendicitis are related.