Sepsis caused by Salmonella serovar paratyphi B in immunocompromised patient with kasabach-merritt syndrome in dr. Soetoro general academic hospital Surabaya: a case report

Main Article Content

Suharyadi Sasmanto
Eddy Bagus Wasito


Sepsis, Salmonella paratyphi B, Kasabach-Merritt Syndrome


Introduction: Salmonella species are recognized worldwide as a common cause of childhood infections, particularly gastroenteritis, bacteremia, and enteric fever. Some salmonella infection cases, especially those caused by Salmonella paratyphi B, which are rare, are reported to cause sepsis in children and neonates. The treatment of Salmonella paratyphi B-induced sepsis is challenging, particularly in immunocompromised babies as in Kasabach-Merritt Syndrome (KMS). This case report aims to report the case of a 1.7-year-old girl who had Salmonella serovar paratyphi B-induced sepsis and presented with KMS.

Case description: A 1.7 years old girl has complaints of fever for 5 days prior to admission to the hospital with a history of a growing haemangioma in the abdominal area since the first 40 days since birth. The patient was diagnosed with KMS. During the period of hospitalization, there were no complaints of fever, therefore, the patient was discharged. The next day, the patient complained of persistent fever and general weakness.

Vital signs examination revealed tachycardia and hyperthermia. Laboratory results showed the hemoglobin was 8.7 gr/dL, leucocyte 20.640/uL, neutrophil 65%, lymphocyte 20.5%, platelet 14.000 uL, CRP 14.22 mg/dL. The patient was diagnosed with Kasabach-Merritt Syndrome (KMS) and has been in control as an outpatient and received oral therapy with methylprednisolone, propranolol and tranexamic acid. The patient was readmitted for chemotherapy with bleomycin and vincristine as part of the KMS treatment regimen. Empiric antibiotic (200 mg ampicillin i.v.) also administered as Salmonella sp. Bacteria was found on the blood culture.

Conclusion: Salmonella paratyphi B is a rare infection, the symptoms are typically mild. Rapid identification of bacterial infection and antimicrobial susceptibility testing is crucial for effective treatment.

Abstract 308 | pdf Downloads 220


1. Haisley-Royster C, Enjolras O, Frieden IJ, Garzon M, Lee M, de Laat PCJ, et al. Kasabach-Merritt phenomenon: a retrospective study of treatment with vincristine. J Pediatr Hematol Oncol. 2002;24(6):459–62.
2. Wang P, Zhou W, Tao L, Zhao N, Chen XW. Clinical analysis of Kasabach-Merritt syndrome in 17 neonates. Bmc Pediatr. 2014;14(1):1–7.
3. Mahajan P, Margolin J, Iacobas I. Kasabach-Merritt phenomenon: classic presentation and management options. Clin Med Insights Blood Disord. 2017;10:1179545X17699849.
4. Arunachalam P, Kumar VRR, Swathi D. Kasabach–Merritt syndrome with large cutaneous vascular tumors. J Indian Assoc Pediatr Surg. 2012;17(1):33.
5. Choeyprasert W, Natesirinilkul R, Charoenkwan P. Successful treatment of mild pediatric kasabach-merritt phenomenon with propranolol monotherapy. Case Rep Hematol. 2014;2014.
6. Yadav D, Maheshwari A, Aneja S, Seth A, Chandra J. Neonatal Kasabach-Merritt phenomenon. Indian J Med Paediatr Oncol. 2011;32(04):238–41.
7. Marliah E, Gatot D. Sindrom Kasabach-Merritt. Sari Pediatr. 2016;6(3):110–4.
8. Osman NM. Kasabach–Merritt syndrome: A case report. Sudan J Paediatr. 2013;13(1):49.
9. Croteau SE, Liang MG, Kozakewich HP, Alomari AI, Fishman SJ, Mulliken JB, et al. Kaposiform hemangioendothelioma: atypical features and risks of Kasabach-Merritt phenomenon in 107 referrals. J Pediatr. 2013;162(1):142–7.
10. Kelly M. Kasabach-Merritt phenomenon. Pediatr Clin North Am. 2010 Oct;57(5):1085–9.
11. Putra J, Gupta A. Kaposiform haemangioendothelioma: a review with emphasis on histological differential diagnosis. Pathology. 2017;49(4):356–62.
12. O’Rafferty C, O’Regan GM, Irvine AD, Smith OP. Recent advances in the pathobiology and management of Kasabach-Merritt phenomenon. Br J Haematol. 2015 Oct;171(1):38–51.
13. Ryan C, Price V, John P, Mahant S, Baruchel S, Brandão L, et al. Kasabach–Merritt phenomenon: a single centre experience. Eur J Haematol. 2010;84(2):97–104.
14. Lewis D VR. Kasabach Merritt Syndrome [Internet]. StatPearls Publishing. 2022 [cited 2022 Oct 2]. Available from:
15. Crump JA, Mintz ED. Global trends in typhoid and paratyphoid fever. Clin Infect Dis. 2010;50(2):241–6.
16. Waddington CS, Darton TC, Pollard AJ. The challenge of enteric fever. J Infect. 2014;68:S38–50.
17. Higginson EE, Ramachandran G, Hazen TH, Kania DA, Rasko DA, Pasetti MF, et al. Improving our understanding of Salmonella enterica serovar Paratyphi B through the engineering and testing of a live attenuated vaccine strain. Msphere. 2018;3(6):e00474-18.
18. Baker S, Blohmke CJ, Maes M, Johnston PI, Darton TC. The current status of enteric fever diagnostics and implications for disease control. Clin Infect Dis. 2020;71(Supplement_2):S64–70.
19. Crump JA. Progress in typhoid fever epidemiology. Clin Infect Dis. 2019;68(Supplement_1):S4–9.
20. Bula-Rudas FJ, Rathore MH, Maraqa NF. Salmonella infections in childhood. Adv Pediatr. 2015;62(1):29–58.
21. Alhaj-Qasem DM, Al-Hatamleh MAI, Irekeola AA, Khalid MF, Mohamud R, Ismail A, et al. Laboratory diagnosis of paratyphoid fever: Opportunity of surface plasmon resonance. Diagnostics. 2020;10(7):438.
22. Khanam F, Rajib NH, Tonks S, Khalequzzaman M, Pollard AJ, Clemens JD, et al. Case report: Salmonella enterica serovar paratyphi B infection in a febrile ILL child during enhanced passive surveillance in an urban slum in Mirpur, Dhaka. Am J Trop Med Hyg. 2020;103(1):231.
23. Buckle GC, Walker CLF, Black RE. Typhoid fever and paratyphoid fever: systematic review to estimate global morbidity and mortality for 2010. J Glob Health. 2012;2(1).
24. Gibani MM, Britto C, Pollard AJ. Typhoid and paratyphoid fever: a call to action. Curr Opin Infect Dis. 2018;31(5):440.
25. Amicizia D, Arata L, Zangrillo F, Panatto D, Gasparini R. Overview of the impact of Typhoid and Paratyphoid fever. Utility of Ty21a vaccine (Vivotif®). J Prev Med Hyg. 2017;58(1):E1.
26. Neupane DP, Dulal HP, Song J. Enteric fever diagnosis: Current challenges and future directions. Pathogens. 2021;10(4):410.
27. Williams DM. Clinical pharmacology of corticosteroids. Respir Care. 2018;63(6):655–70.
28. Rubio MT, Ittelet D, Raymond E, Blay JY, Bernard J, Chouaib S. The immunosuppressive effect of vincristine on allostimulatory potential of human dendritic cells interferes with their function and survival. Int J Oncol. 2004;25(2):407–12.
29. Youssef J, Novosad SA, Winthrop KL. Infection risk and safety of corticosteroid use. Rheum Dis Clin. 2016;42(1):157–76.
30. Drolet BA, Trenor CC 3rd, Brandão LR, Chiu YE, Chun RH, Dasgupta R, et al. Consensus-derived practice standards plan for complicated Kaposiform hemangioendothelioma. J Pediatr. 2013 Jul;163(1):285–91.
31. Wang H, Duan Y, Gao Y, Guo X. Sirolimus for Vincristine-Resistant Kasabach-Merritt Phenomenon: Report of Eight Patients. Pediatr Dermatol. 2017 May;34(3):261–5.
32. Wang Z, Li K, Dong K, Xiao X, Zheng S. Refractory Kasabach-Merritt phenomenon successfully treated with sirolimus, and a mini-review of the published work. J Dermatol. 2015 Apr;42(4):401–4.
33. Chinello M, Di Carlo D, Olivieri F, Balter R, De Bortoli M, Vitale V, et al. Successful management of kaposiform hemangioendothelioma with long-term sirolimus treatment: a case report and review of the literature. Mediterr J Hematol Infect Dis. 2018;10(1).
34. Fernandez-Pineda I, Lopez-Gutierrez JC, Ramirez G, Marquez C. Vincristine-ticlopidine-aspirin: an effective therapy in children with Kasabach-Merritt phenomenon associated with vascular tumors. Pediatr Hematol Oncol. 2010;27(8):641–5.
35. Fernandez‐Pineda I, Lopez‐Gutierrez JC, Chocarro G, Bernabeu‐Wittel J, Ramirez‐Villar GL. Long‐term outcome of vincristine–aspirin–ticlopidine (VAT) therapy for vascular tumors associated with kasabach–merritt phenomenon. Pediatr Blood Cancer. 2013;60(9):1478–81.
36. Moimeaux V, Taieb A, Legrain V, Meraud J, Jimenez M, Choussat A. Aspirin-ticlopidin in Kasabach-Merritt syndrom. Lancet (British Ed. 1992;340(8810).
37. Veeraraghavan B, Pragasam AK, Bakthavatchalam YD, Ralph R. Typhoid fever: issues in laboratory detection, treatment options & concerns in management in developing countries. Futur Sci OA. 2018;4(6):FSO312.
38. Dahiya S, Malik R, Sharma P, Sashi A, Lodha R, Kabra SK, et al. Current antibiotic use in the treatment of enteric fever in children. Indian J Med Res. 2019;149(2):263.
39. KaushiK D, Mohan M, BoraDe DM, Swami OC. Ampicillin: rise fall and resurgence. J Clin diagnostic Res JCDR. 2014;8(5):ME01.
40. Rai S, Rai R, Singh DK, Nandwani S. Neonatal Salmonella Paratyphi B Sepsis: A Case Report. J Neonatol. 2020;34(4):241–2.