A 36-year-old male with typhoid fever presented with conduction aphasia and parietal lobe dysfunction due to an infarct in the left posterior parieto-temporal cortex documented by CT Scan. This case highlights an unusual neurological complication of typhoid fever hitherto not reported in the literature. Introduction Typhoid fever caused by Salmonella group of organisms has a high prevalence in tropical countries of Asia and Africa. Classically described clinical manifestations are rarely encountered due to early diagnosis and institution of antibiotic therapy. Of all the complications described in typhoid fever, the neuropsychiatric manifestations are the most varied and fascinating for the medical world. Here we present a case of typhoid fever developing cortical infarction with aphasia and parietal lobe dysfunction. Case Report A 36-year-old male was admitted to the hospital with 20 days history of fever and headache. He was receiving treatment before admission to our hospital as typhoid fever based on positive Widal test (initial titre 1:80 later 1:320) with ciprofloxacin and gentamycin. On the day of admission, there was history of sudden onset of giddiness with altered sensorium for one hour. Following this, the patient became responsive but was unable to communicate freely due to reduced word output for which he was brought to the hospital.Clinical examination showed an anxious, febrile (39.6° C) patient with mild splenomegaly. The patient was conscious, well oriented, with well-preserved comprehension for spoken words, but had severely impaired naming and repetition. No focal motor deficit was present. All primary modalities of sensations were intact. However, tactile localization and two-point discrimination were impaired on right half of the body. Parietal lobe dysfunction was documented by presence of dyscalculia, ideational apraxia with inattention to tactile and auditory stimulation. Right to left disorientation and finger anomia were also present. Reading and writing could not be tested in detail, as the patient was not literate, and could write only his name. No visual field defect was documented.Haemoglobin concentration was 15.3g/dL, white blood cell count was 6900cells/mm3, platelet count was 2,18,000/mm3 and ESR was 20mm in the first hour. Biochemical parameters were normal. Chest X-ray was normal. Mantoux test and serology for HIV were negative. Malaria and urinary tract infections were ruled out.A diagnosis of typhoid fever was considered in view of Widal test being strongly positive (1:640 titer after admission for both somatic and flagellar antigen). A rising titer was also documented. Blood cultures were sterile, probably due to prior antibiotic therapy.CT scan of the brain revealed a hypo-dense lesion involving the left posterior parieto-temporal cortex suggestive of an early infarct (Figure 1). Lumbar puncture showed normal opening pressure and CSF analysis revealed no abnormality.
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