enteric fever is endemic in developing countries such as india where sanitary conditions and potable water is not accessible to all .
patients typically present at the end of the first week after the onset of symptoms with fever , influenza - like symptoms with a dull frontal headache , malaise , etc . , but with few physical signs . a coated tongue , tender abdomen , hepatomegaly , and splenomegaly are common .
blanching erythematous maculopapular lesions commonly called  rose spots are reported in 530% of cases .
if untreated or where the implicated organism is resistant to the treatment being given , there may be seeding of salmonellae in various organs of the body .
, such as liver , splenic , and anterior abdominal wall , but bilateral breast abscesses are a rare presentation .
we present here a rare case of a young nonlactating , immunocompetent female who presented with bilateral breast abscesses due to salmonella typhi .
a 29-year - old female presented to the surgical outpatient department ( opd ) at our hospital with the complaint of a lump in both the breasts for 7 days associated with pain .
the lumps were felt around the nipple , tender to touch with the overlying skin warm .
fever was high grade with a peak of 39c and touched baseline only with the intake of antipyretics .
two weeks prior to the development of breast pain and lump , the patient had visited the medical outpatient department with the complaint of fever .
she was empirically started on amoxicillin plus clavulanic acid 625 mg bid for 7 days , but did not respond and continued to have fever .
although the blood culture had grown salmonella typhi and the isolate was resistant to ampicillin , she did not visit the hospital for follow - up and so the treatment could not be modified accordingly .
she was a mother of two children , but at presentation she was neither pregnant nor lactating . on examination ,
there was a centrally located lump in the left breast measuring around 8  8 cm and another lump in her right breast just below the areola measuring around 3  3 cm .
a palpable axillary lymph node around 2 cm in size was present on the left side .
pus was drained from both the sides , which on culture grew non - lactose - fermenting colonies .
the organism was identified as salmonella typhi by biochemical reactions and agglutination test with specific antisera .
the isolate was sensitive to chloramphenicol , cefotaxime , ciprofloxacin , and co - trimoxazole but resistant to ampicillin and nalidixic acid .
the patient had a report of a positive blood culture for salmonella typhi from our laboratory 2 weeks prior to the presentation , which had a similar sensitivity pattern .
the widal test showed a negative result with the titer of to=160 and th and ah=40 .
her hemogram revealed normal values [ haemoglobin ( hb ) : 10.4 g / dl , total leukocyte count ( tlc ) : 10,000/mm , differential leukocyte count ( dlc ) ; neutrophils : 80% ; lymphocytes : 18% ; eosinophils : 2% ] .
biochemistry investigations were also within normal limits except that her serum glutamic oxaloacetic transaminase ( sgot ) and serum glutamic pyruvic transaminase ( sgpt ) were raised with values of 96.59 and 113.78 u / l , respectively .
the patient was started on oral ciprofloxacin 500 mg bid for 2 weeks to which she responded favorably with regression of the lesion .
the stool and urine cultures were negative for salmonella typhi during presentation and subsequent visits .
it is capable of forming abscesses in various organs such as liver , subcutaneous tissue , muscles , and skin .
the possible causes may be infective bile from carriers , hematogenous spread from distant site , and lymphatic spread from gastrointestinal tract . bilateral breast abscesses due to salmonella typhi
the occurrence of breast abscesses in patients with typhoid has been shown to be around 0.3% by klose and sebening ( 1930 ) and 0.5% by pezinski ( 1937 ) in a study of 1 196 cases of typhoid over a period of 2 years . in females ,
other authors have also reported similar cases of unilateral breast abscess due to salmonella typhi .
razeq et al and edelstein et al had isolated salmonella landweisser and salmonella serogroup b in breast abscess , respectively . in a recently published study from kuwait , a very rare serotype , salmonella enterica serotype poona , was isolated from a case of breast abscess that was associated with erythema nodosum .
on analyzing the available literature on breast abscesses due to salmonella spp . , we found that most of the patients were immunocompetent females between the ages of 23 and 45 years .
however , no common predisposing factors could be elucidated . in the present case , besides fever , which could also be a feature of breast abscess , there was no other clinical feature of typhoid .
the patient had been initially started on amoxicillin in combination with clavulanic acid , but as the strain was resistant to it she did not show any response .
the patient did not turn up for the scheduled follow - up after the blood culture and sensitivity report , leading to the progression of the disease and localization in the breast tissue .
it was only when she visited the surgical opd 2 weeks later with the complaint of bilateral breast abscesses , the pus could be drained and was sent for culture and sensitivity testing .
the patient responded to oral ciprofloxacin with reduced swelling of the abscesses and was afebrile thereafter .
any breast abscess in a nonlactating female with a history of typhoid fever in the recent past and no other predisposing factors must be evaluated , keeping the possibility of a salmonella breast abscess in mind .
also , a combination of medical and surgical management helps in such a case when supported by a microbiological culture and sensitivity report .
 focal infection is an uncommon complication of salmonella septicemia , particularly in immunocompetent patients . 
 the localization of salmonella infection to breast tissue is regarded as a rare event . 
 we report a case of bilateral breast abscesses due to salmonella enterica serotype typhi in a nonlactating female and highlight the fact that salmonella spp . should be included in differential diagnosis of abscesses in individuals coming from endemic areas with the history of recent typhoid fever and should be treated accordingly . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION