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Paper text:
an 8-year - old girl was admitted to the pediatric department of the balaji hospital , chrompet , chennai with the complaints of with high grade fever of 4 days duration associated with nonbilious vomiting , watery stools , abdominal pain , and reduced appetite .
a complete blood count showed a total white cell count of 3000 with a differential count of 78% neutrophils , 20% lymphocytes , 2% eosinophils .
liver function tests showed a total serum bilirubin of 0.5 , direct of 0.2 and indirect of 0.3 .
serum glutamic pyruvic transaminase - 49 , serum glutamic oxaloacetic transaminase - 117 , albumin - 3.7 and globulin - 2.5 .
serum electrolytes revealed a sodium level of 122.1 , potassium of 3.54 and chloride 92.6 .
ascites , hepatosplenomegaly , mesenteric lymphadenopathy and gall bladder thickening were obtained in abdominal ultrasound .
a diagnosis of multi - drug resistant typhoid fever with thrombocytopenia , hyponatremia , mesenteric adenitis and ascites was made .
thrombocytopenia is prevalent in 1015% of children with typhoid fever according to a study done by ur rab and beig of the department of pediatrics of j.n .
ascites is an underreported finding in enteric fever according to sinha of shishuniketan kolkata , india as published in indian pediatrics .
mild hyponatremia has been reported in typhoid fever as are multi - drug resistant cases .
we are not aware of a combination of all these complications in a single patient , as revealed by a literature search using the internet .
a rare case of typhoid presenting with thrombocytopenia , hyponatremia , ascites mesenteric adenitis , and multi - drug resistance is being presented in this article . 
 an 8-year - old girl was admitted with a history of fever , vomiting , abdominal pain and loose stools . 
 clinical examination revealed fever and hepatosplenomegaly . 
 investigations showed leucopenia , thrombocytopenia and hyponatremia . 
 blood widal was positive , and blood culture grew salmonella typhi . 
 ultrasound abdomen revealed ascites , hepatosplenomegaly , mesenteric lymphadenopathy and thickening of the gall bladder . 
 she was treated with ciprofloxacin intravenously for 6 days and when the fever persisted injection ceftriaxone was added . 
 ciprofloxacin was given intravenously for a total of 15 days and injection ceftriaxone was given for 12 days . 
 even then , the fever persisted and hence oral azithromycin was added . 
 fever subsided completely in 3 days with azithromycin and she became asymptomatic without fever , loose stools , abdominal pain or anything on follow - up after 3 months .