Hickam's Victim: The Unwary Diagnostician

In this case report, the authors describe a woman, some 82 years of age who had immigrated from Korea 30 years prior to presenting with syncope and dehydration, which was soon discovered to be Salmonella enterica subspecies typhi. Despite urine culture growing gram negative rods, 

"CT of chest, abdomen, and pelvis without contrast was ordered to better characterize the source of her sepsis."

Ignoring that we already have a source for her sepsis (indeed the most common source: urosepsis), and that gram negative sepsis almost never originates from the chest, we will move on after noting that they found multiple cavitary lesions in the upper lobes of the lungs. The authors state that they tried to link the cavitary lung disease with the urinary tract infection (staghorn calculi were found too!) and Salmonella bacteremia, because of an inclination towards Ockham's razor, but alas learned that the chest disease was tuberculosis (who knew!?) so they invoke Hickam's dictum. I rather think that this is a case of Crabtree's bludgeon which states that:

"No set of mutually inconsistent observations can exist for which some human intellect canno t conceive a coherent explanation, however complicated."

Alas, much about the epidemiology and natural history of both Salmonella and tuberculosis in this case report was neglected, so I penned this letter to the editor, below. I did not receive confirmation of my submission, and this journal's website is a bit inchoate, so I assume my letter was lost....

Added on 10/6/2025: Actually, my letter was not lost, as I received an acceptance letter today, but only after the invoice charging me $1530.00 USD as a publication fee for a letter to the editor! But let me tell you, the reviews, wherever they came from, were over the moon with my "clinical acumen" and "insightful analysis".

I replied saying nevermind, I can't afford that charge to publish a *letter* They replied saying "how much can you afford?" I offered $200 and it was immediately accepted. Never overlook the value of flattery, or the cold hard dollar. 

So I will link the letter, after it is published. In the meantime, comment below if you have your own insights about the case.