Neuropsychiatric presentation in paratyphoid fever is not a well-known entity. In countries such as Australia, where the prevalence of enteric fever is one of the lowest, this presentation seems to be unlikely.

We present a case that demonstrates the importance of considering this possibility in Australian context in returned travellers.

A young male, who recently returned to Australia from his home country in South East Asia, presented with abnormal behaviour in the context of febrile illness. His behaviour was characterised by grandiosity, aggression, hallucinatory behaviour and paranoia, along with disturbed biological functions. Detailed inpatient assessment revealed him to be suffering from Salmonella Paratyphi A infection and psychotic illness because of his general medical condition. Although his fever and inflammatory markers responded to antibiotics, antipsychotics were required for treatment of his mental health problems.

This case demonstrates that paratyphoid fever, which is considered to be a less common variant of enteric fever, can present with neuropsychiatric manifestations.