https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/239 Wed, 05 Jul 2017 15:20:49 +0000 Abstract Ibrahim Med. Coll. J. 2013; 7(1): 16-17 Key words: Salmonella Typhi, breast abscess, asymptomatic typhoid fever.   Address for Correspondence:Prof. J. Ashraful Haq, Department of Microbiology, Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue, Dhaka-1000. E-mail: jahaq54@yahoo.com     Typhoid fever is a common febrile illness in many developing countries of the world including Bangladesh. It is caused by Salmonella enteric serovar Typhi (S. Typhi) and Paratyphi A, B and rarely C. Extra-intestinal manifestations of typhoid fever such as abscess due to Salmonella Typhi are not common. Infection due to S. Typhi is occasionally associated with abscess formation in various organs namely pancreas, brain, liver, spleen, muscle and breast.1-6 The abscess due to S. Typhi during typhoid is always associated with specific clinical features of enteric fever. But the presence of abscess without the general and specific symptoms of typhoid fever is unusual. We describe here a rare case of breast abscess without the presence of general and specific symptoms of typhoid fever in a young diabetic female. Case Report She gave a history of high grade fever and malaise one month prior to the appearance of the swelling in the breast and treated irregularly with various antibiotics by local doctors. There was no past history of any breast disease. She had no loose motions, constipation or urinary abnormality nor had she taken any vaccination against S. Typhi. She was diabetic (type-2) for last two years and on oral anti-diabetic agents with irregular follow up for blood glucose control.   S. Typhi causes typhoid which is a multisystem disease with generalized manifestations. Among the known extra intestinal manifestations, breast abscess due to S. Typhi is rare. In a large study conducted in India on 6250 cases of salmonellosis, 0.016% cases had focal pyogenic infection with only one case of breast abscess.8 Literature review revealed few published cases of breast abscess due to S.Typhi.9-14 Unlike our case, all the reported breast abscess cases due to S. Typhi had general and specific features of enteric fever. But our patient presented with a swelling in her left breast without fever or any other features of enteric fever. But, after the isolation of S. Typhi from the pus, on further enquiry, the patient revealed that she had an acute episode of fever one month prior to the development of breast swelling. Therefore, it appears that she might have had an attack of typhoid fever and the organism got seeded in breast tissue during the bacterimic phase of the diseases. It became reactivated because of her uncontrolled glycemic status (blood sugar level 27mmol/l) and diabetes. There were two other case reports which described abscess in testis and psoas muscle due to S. Paratyphi and S. Typhi respectively without fever or any other specific features of typhoid fever.15,16 References 2.    Hanel RA, Araújo JC, Antoniuk A et al. Multiple brain abscesses caused by Salmonella typhi: case report. Surg Neurol 2000; 53: 86-90. 4.    Naranje KM, Devidayal, Sodhi KS and Singh M. Multiple splenic abscesses caused by Salmonella typhi in a child: case report and brief literature review. J Ped Scien 2011; 3: e113. 6.    Singh S, Pandya Y, Rathod J and Trivedi S. Bilateral breast abscess: A rare complication of enteric fever. Indian J Med Microbiol 2009; 27: 69-70. 8.    Lalitha MK and John R. Unusual manifestations of salmonellosis: A surgical problem. Quarter J Med 1994; 87: 301-309. 10.  Viswanathan R, Shah AH, Nagori LF and Gupta MK. Salmonella typhi in breast abscess. Bombay Hospit J 2003; 45: 452. 12.  Mahajan RK, Duggal S, Chande DS et al. Salmonella enterica serotype Typhi from a case of breast abscess. J Commun Dis 2007; 39: 201-4. 14.  Salahuddin U, Tambawala A and Salahuddin N. Breast abscess and acute cholangitis:Two rare manifestations of Salmonella typhi in the same patient. Infect Dis J Pakistan 2008; 17: 27-29. 16.  Shakespeare WA, Davie D, Tonnerre C et al.. Nalidixic acid resistant Salmonella enterica Serotype Typhi presenting as a primary psoas abscess: Case report and review of the literature. J Clin Microbiol 2005; 43: 996-998. 2026 Ibrahim Medical College. All rights reserved.