A 66-year-old lady presented with 4 months history of intermittent fever, epigastric pain which radiated to the back. She reported no symptoms of diarrhoea or constipation. She did not smoke and had no history of alcohol intake. She was premorbidly independent. Her blood pressure was 123/62 mmHg, pulse 90 beats per minute and she was febrile. Abdominal examination revealed epigastric and periumbilical area tenderness. Laboratory blood investigations showed white cell count of 8.6 x 109/l with neutrophilia predominance of 81%. She had haemoglobin of 10.9g/dl and platelet of 134 x 109/l. Her infective markers were raised with erythrocyte sedimentation rate (ESR) of 114mm/hr and C-reactive protein (CRP) at 37 mg/l. She had a normal renal profile. Blood culture taken on admission was identified to be Salmonella paratyphi B.
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