Atypical presentation of scrub typhus encephalitis with cerebral hemorrhage
DOI:
https://doi.org/10.18203/2320-6012.ijrms20222290Keywords:
Scrub typhus, Encephalitis, Cerebral hemorrhage, Atypical scrub typhus, Hemorrhagic manifestationAbstract
Scrub typhus, an arthropod borne infection caused by the rickettsial organism Orientia tsutsugamushi, is a fairly common disease in north-eastern sub-Himalayan India, particularly the forest areas, and is known to manifest with varied presentations ranging from non-specific fever to severe multi-organ complications. Hemorrhagic manifestations described in the literature are mostly gastrointestinal and genitourinary, secondary to vasculitis and/or thrombocytopenia, but reports of cerebral hemorrhage have been extremely rare. We report a case from sub-Himalayan eastern India where a 23 years old male tea plantation worker presented with recurrent convulsions with magnetic resonance imaging (MRI) brain showing multiple parenchymal hemorrhages with encephalitis involving both the cerebral hemispheres. Although patient developed fever and acute kidney injury later in the course, these were not the presenting complaints despite fever being the most consistent sign of a scrub typhus infection. We suggest consideration of scrub typhus as a differential diagnosis of a cerebral hemorrhage in endemic regions.
References
Xu G, Walker DH, Jupiter D, Melby PC, Arcari CM. A review of the global epidemiology of scrub typhus. PLoS Negl Trop Dis. 2017;11(11):e0006062.
Jeong YJ, Kim S, Wook YD, Lee JW, Kim KI, Lee SH. Scrub typhus: clinical, pathologic, and imaging findings. Radiographics. 2007;27(1):161-72.
Rapsang AG, Bhattacharyya P. Scrub typhus. Indian J Anaesth. 2013;57(2):127.
Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry. 2015;86(7):761-6.
Rajapakse S, Weeratunga P, Sivayoganathan S, Fernando SD. Clinical manifestations of scrub typhus. Trans R Soc Trop Med Hyg. 2017;111(2):43-54.
Sood AK, Chauhan L, Gupta H. CNS manifestations in Orientia tsutsugamushi disease (scrub typhus) in north India. Indian J Pediatrics. 2016;83(7):634-9.
Kim HC, Yoon KW, Yoo DS, Cho CS. Hemorrhagic transformation of scrub typhus encephalitis: A rare entity. Clin Neuroradiol. 2015;25(4):415-8.
Yang SH, Wang LS, Liang CC, Ho YH, Chang ET, Cheng CH. Scrub typhus complicated by intracranial hemorrhage-A case report. Tzu Chi Med J. 2005;17(2):111-4.
Kim DM. Clinical features and diagnosis of scrub typhus. Infect Chemother. 2009;41(6):315-22.
Prakash JA. Scrub typhus: risks, diagnostic issues, and management challenges. Res Rep Trop Med. 2017;8:73.