Torsade de pointes caused by salmonella Typhi infection

Background. Torsade de pointes is a life threatening arrhythmia that is commonly a result of long QT syndromes from different causes. Case: A 44 year-old previously healthy woman, who had recently traveled to Asia, presented to the ER complaining of high fevers, headache, constipation, and abdominal pain for one week. On the third day of hospitalization of the patient an EKG was done due to chest discomfort and showed normal sinus rhythm (NSR) with a normal QT interval. One hour later, the patient complained of worsening shortness of breath, tachypnea, and became unresponsive. The initial rhythm on the cardiac monitor revealed Torsade de Pointes. The patient was defibrillated once with 150J with conversion back to sinus rhythm. A transthoracic echocardiogram (TTE) showed LVEF of 15% with global hypokinesia. Final blood cultures grew Salmonella typhi. Episodes of polymorphic VT were observed until day 6. After antibiotic treatment the patient had resolution of arrhytmia with normal TTE and cardiac MRI. This case is unique because all the common etiologies of torsade de pointes were ruled out, the EKGs before and after the event showed a NSR with normal QT intervals and absence of known causes of acquired long QT syndrome. She was diagnosed with polymorphic VT with normal repolarization, which leads us to the conclusion that the potentially fatal arrhythmia was a result of the Salmonella typhi bacteremia and a likely resultant myocarditis. In our case, not only was the cardiovascular complication caused by an atypical salmonella species, but the presence of torsade de pointes in this patient is also a very rare finding. Conclusion: The recognition of rare, although potentially serious, arrhythmic complications of a salmonella infection are important in the management of these patients. To the best of our knowledge, this is the first case of torsade de pointes resulting from a Salmonella typhi infection.