Sick sinus syndrome--a rare complication of typhoid fever.

A 10 year old male presented with high grade continuous fever for 15 days to the pediatric ward of LNJPN Hospital. The fever was not associated with respiratory distress, alteration of sensorium or seizures. Examination revealed a sick looking child, conscious with cold extremities, normal JVP, a pulse rate of 120 per minute, regular, low volume with a blood pressure of 68/40 mm Hg. The spleen was 2 cm below the costal margin and liver was just palpable. Chest, cardiovascular and central nervous system were clinically normal. A provisional diagnosis of enteric fever with shock (circulatory collapse) was made. The investigations revealed a hemoglobin of 8.5 g/dl, TLC 2750 cells/mm, DLC P76 L22 M2 Peripheral smear revealed normocytic normochromic anemia with toxic granules in leucocytes. Widal test was positive with a TO 1:800 and TH 1:800. Blood culture grew Salmonella typhi. The subject was administered injection ciprofloxacin and dopamine infusion to combat hypotension. There was a progressive decline in heart rate which became irregularly irregular and attained the rate of 50 per minute 12