CASE REPORT Isolated thrombocytopenia: the presenting finding of typhoid fever K. SEREFHANOGLU*, E. KAYA , A. SEVINC , I. AYDOGDU , I. KUKU , Y. ERSOY* Departments of *Infectious Diseases and Clinical Microbiology and  Haematology, School of Medicine, Turgut Ozal Medical Center, Inonu University, Malatya, Turkey Summary Thrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when Salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed. Keywords Fever, isolated thrombocytopenia, Salmonella typhi Introduction Typhoid fever, the prototype of enteric fever, is caused by Salmonella typhi. Typhoid fever is a major problem for people living in developing countries where there is poor sanitation and faecal contamination of food and water. The organisms multiply in intestinal lymphoid tissue and then disseminate via the lymphatic or haemato- genous route. Salmonella spp. grow intracellularly, pri- marily in reticuloendothelial cells in lymph nodes, spleen, liver and bone marrow (Pearson & Guerrant, 2000). Signs and symptoms associated with typhoid fever include fever, chills, myalgias, abdominal pain, headache, rose spots, cough and sore throat (Shere et al., 1998). Haematological abnormalities associated with typhoid fever include leucopenia and anemia (Miller & Pegues, 2000). Thrombocytopenia is typically seen as a complica- tion during the course of typhoid fever (Seebaran et al., 1990; Sarnighausen et al., 1999; Chiu et al., 2000). We reported this typhoid fever case because of an unusual haemotological presentation, with thrombocytopenia on admission. Case A 29-year-old man was admitted to the hospital with complaints of fever, diarrohea, abdominal pain, myalgias, headache and nonproductive cough for 1 week. The fever was preceded by chills and persisted throughout the day. He had had a watery diarrhoea (3–4 times/day) that was accompanied by abdominal pain. At the time of admission, his physical examination was normal, except for fever of 39.5 °C. A complete blood count showed Hb 134 g/l, Hct 0.40, MCV 87.6 fl, WBC 4.1 · 10 9 /l and a significantly decreased platelet count of 1 · 10 9 /l. A peripheral blood smear revealed 78% neutrophils, 20% lymphocytes, 2% monocytes and rare giant platelets. The C-reactive protein (CRP) was 93.7 mg/l (normal range: 0–5 mg/l). Bio- chemical examination revealed elevated levels of alanine aminotransferase (ALT), aspartate amino transferase (AST), and lactic dehidrogenase (LDH) (150, 174 and 1073 U/l, respectively). Stool examination revealed leu- cocytes but no erythrocytes and parasites. The erythrocyte Accepted for publication 10 September 2002 Correspondence: Ismet Aydogdu, MD, Department of Haematology, School of Medicine, Turgut Ozal Medical Center, Inonu University, Malatya, TR44069, Turkey. Fax: +90 422 3410728 29, E-mail: iaydogdu@inonu.edu.tr Clin. Lab. Haem. 2003, 25, 63–65 Ó 2003 Blackwell Publishing Ltd. 63