A patient with typhoid fever, Giardia lamblia gastroenteritis and hepatitis E

Marked elevation of transaminases is rare in typhoid enteric fever. Co-infections with hepatitis A or E, dengue, or other pathogens should be suspected and investigated. Here we report a case of a 29-year-old Bangladesh man who presented with typhoid, hepatitis E and Giardia lamblia complicated by severely deranged liver enzymes. With early institution of antibiotics and active supportive treatment, the patient clinically recovered. The underlying mechanism of co-infection is still not clear. As clinicians, comprehensive workup for potential pathogens helps expedite diagnosis, especially in patients from endemic areas or patients who deteriorate rapidly. Current diagnostic methods, treatment modalities and preventive measures still need to be improved in the future.