In 2018, Pakistan, a low income country of South Asia, had the highest rate of Salmonella enterica serotype Typhi (S Typhi) cases compared to other South Asian countries including India [1]. The emergence of the extensively drug resistant (XDR) strain of S Typhi in Pakistan, has only made it difficult for authorities to control this endemic [1]. An estimated 15000 cases of XDR typhoid fever have been reported in Pakistan till date [2].

S Typhi effects the gastrointestinal system with the patient primarily suffering from fever, diarrhea and vomiting. Presence of Salmonella serotypes in urinary tract are exceptionally rare, accounting for less than 1% of urinary tract infection (UTI) cases [3]. Such patients may present with typical genitourinary manifestations including dysuria and frequent urination [4]. We report the first documented case of a 74 years old male patient presenting with relapsed UTI secondary to XDR S Typhi.