Probable hemophagocytic lymphohistiocytosis by extensively drug‐resistant Salmonella Typhi

Cefdinir was started on day 9, however, on day 11, the patient had persistent fever and blood tests revealed thrombocytopenia. [...]she was referred to our hospital and admitted for suspected HLH (day 1 of hospitalization). On day 5 of hospitalization, antimicrobial susceptibility testing of the isolate revealed resistance to ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin, azithromycin, and ceftriaxone, with susceptibility to meropenem (Table 1). XDR S. Typhi has acquired resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole), fluoroquinolones, and third-generation cephalosporins. 2 XDR S. Typhi has plasmid-encoding resistance elements (blaCTX-M-15 extended-spectrum β-lactamase) and carries the qnrS-fluoroquinolone-resistance gene. 2 Since November 2016, 339 XDR typhoid cases have been reported in Sindh, Pakistan.