Nalidixic acid-resistant Salmonella enterica serotype typhi infection presenting with sub-intestinal obstruction and mesenteric adenitis

Nalidixic acid-resistant Salmonella typhi (NARST) infections increase minimal inhibitory concentrations of fluoroquinolones, due to chromosomal mutations in the gene encoding DNA gyrase, and can lead to a delayed treatment response. This in turn alters the course of the disease allowing for a protracted period of illness and the occurrence of complications. In this case report, we present a patient from the Indian sub-continent, who was diagnosed with NARST complicated by sub-intestinal obstruction, her diagnosis, treatment, and subsequent recovery.