Spontaneous splenic rupture occurs as a rare but life-threatening complication in enteric fever infectionsTyphoid and paratyphoid infections can cause rare splenic rupture

BackgroundEnteric fever, including both typhoid and paratyphoid fevers, is associated with a significant burden of morbidity and mortality in high-epidemic countries. However, as its incidence has declined in most countries, early diagnosis of its complications has become a clinical challenge. Spontaneous splenic rupture (SSR) is a rare but dangerous complication of typhoid fever, and its occurrence in patients with paratyphoid fever remains poorly understood. We report a case of SSR associated with paratyphoid A fever and briefly review the literature.Case presentationA 15-year-old male presented with a one-week history of high fever and fatigue complicated by sudden onset of left upper quadrant abdominal pain for 2 days. Physical examination revealed diffuse abdominal tenderness without rigidity; laboratory studies showed leukocytosis and markedly elevated inflammatory markers. Blood cultures revealed Salmonella enterica serovar Paratyphi A. Contrast-enhanced computed tomography showed splenic rupture and a subcapsular hematoma, peritoneal and pelvic effusion, and peritonitis. He was hemodynamically stable, so we adopted nonoperative management. The patient recovered uneventfully. A search of English-language literature revealed only four reported SSR cases in typhoid fever and two in paratyphoid fever (one Paratyphi A and one Paratyphi B), with a mortality of 33.3% (2/6). All patients either lived in or had traveled back from high-endemic countries.ConclusionSSR is a rare but life-threatening complication of both typhoid fever and paratyphoid fever. Clinical vigilance for this complication should be maintained in patients with suspected enteric fever, even in low-endemic settings.