Introduction: Spontaneous infection of ascitic fluid with Salmonella typhimurium is very rare and exhibits uncommon features.
Observation: A Child-Pugh C cirrhotic 47 year-old woman was hospitalised for fever and coma. Norfloxacin 400 mg per day had been introduced three months earlier as secondary prophylaxis for spontaneous bacterial peritonitis. A spontaneous bacterial peritonitis was diagnosed, and an intravenous broad-spectrum antibiotic therapy was started (cefotaxime 1 g/8h). Bacteriologic samples isolated Salmonella typhimurium in ascites, blood and stools; Escherichia coli sensitive to norfloxacin in blood and Escherichia coli resistant to norfloxacin but sensitive to cefotaxime in urine. Despite the initial regression of the hepatic encephalopathy and the decrease in fever, the patient died twenty days after admission to hospital.
Discussion: This observation is exceptional because of the simultaneous presence of Salmonella typhimurium in ascites, blood and stools. It underlines the features of spontaneous Salmonella bacterial peritonitis: rare, occurring in immuno-suppressive diseases, virulent despite sensitivity to third generation cephalosporines and of often poor prognosis. Compliance to norfloxacin prophylaxis in cirrhotic patients is a real problem, since in the case of poor compliance such patients are exposed both to sensitive norfloxacin bacteria, and to resistant norfloxacin bacteria selected by the norfloxacin prophylaxis.