Decompensation of Cirrhosis: An Unusual Cause

Abstract

We describe a case of a 69-year-old woman, a known case of compensated Hepatitis C cirrhosis, presenting with recurrent urinary tract infection (UTI) secondary to Salmonella Paratyphi B. She had recently tested positive for Salmonella Paratyphi bacteremia associated with UTI, managed with antibiotics. Two weeks later, she presented with fever and burning micturition with signs of abdominal distension and pedal edema suggestive of decompensation of cirrhosis. She had repeat positive urine cultures for Salmonella and was managed with broad-spectrum antibiotics, surgical stone removal, and supportive measures leading to resolution of symptoms and ascites. She was administered a prolonged antibiotic course on discharge for chronic shedding of Salmonella in the urine. UTIs are a common cause of decompensation in immunosuppressed states like liver cirrhosis, and rare infections like salmonella need to be identified and managed appropriately with sensitive antibiotics and the right duration of treatment.

Keywords: hcv cirrhosis; nephrolithiasis; non-typhoidal salmonella (nts); recurrent urinary tract infections; salmonella paratyphi b.

Figure 1. Ultrasonography of the abdomen showed a 15 mm calculus in the proximal right ureter at the pelvic-ureteric junction

Figure 2. Non-contrast CT scan showing calcific calculus in right pelvic-ureteric junction measuring 15mm x 5mm with right hydronephrosis

CT: computed tomography