A 35-year-old British man based in Pakistan presented with a febrile illness, associated with hepatosplenomegaly. Salmonella paratyphi A was isolated from blood cultures and he was treated with oral and intravenous cephalosporins. 3 weeks later, he developed polyarthralgia and right scapular winging. 5 weeks after the initial episode, fevers recurred with new right upper limb neuropathic pain. Examination showed weakness of right serratus anterior, deltoid and triceps, and reduced sensation in left lateral cutaneous nerve of forearm (LCNF) distribution. Neurophysiology showed abnormal sensory responses in the left LCNF and right superficial peroneal nerve, and abnormal EMG in right serratus anterior and right pronator teres. MRI brachial plexus showed no abnormal enhancement in the plexus. CSF was normal. Salmonella paratyphi A was again cultured from blood and he was re-treated. 10 months’ later, he has residual, mild weakness of right deltoid.
Salmonella typhi has been associated with Guillain-Barre syndrome, and can have neuropsychiatric manifestations. The association with a post-infectious polyneuropathy has not previously been reported.
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