Abstract
Abstract
Background
Scrub typhus, caused by Orientia tsutsugamushi, rarely leads to central nervous system involvement. Although intracerebral bleeding is rare due to endemicity and a significant proportion of underdiagnoses, it should be considered a noteworthy differential diagnosis in endemic regions in patients with relevant history and clinical findings.
Case presentation
We present the case of a 40-year-old Nepali woman who visited the emergency department with complaints of left-sided weakness for 6 hours and an acute febrile illness with an eschar for 7 days and was diagnosed with scrub typhus by immunoglobulin M enzyme-linked immunosorbent assay of the serum. Imaging revealed a right-sided frontotemporal hematoma, and further examination revealed pulmonary edema with multiple organ dysfunction syndrome. The patient was mechanically ventilated and was treated with antibiotics, steroids, vasopressors, and antipyretics. However, the hematoma was treated conservatively, with ongoing neurological recovery at the 6-month follow-up.
Conclusion
Although neurological complications and intracranial hemorrhage are uncommon, physicians must be cautious when making differential diagnoses and initiating appropriate therapies to avoid serious or fatal complications.
Publisher
Springer Science and Business Media LLC
Reference16 articles.
1. Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry. 2015;86(7):761–6.
2. Rana A, Mahajan SK, Sharma A, Sharma S, Verma BS, Sharma A. Neurological manifestations of scrub typhus in adults. Trop Doct. 2017;47(1):22–5.
3. Basu S, Chakravarty A. Neurological manifestations of scrub typhus. Curr Neurol Neurosci Rep. 2022;22(8):491–8.
4. Matos AL, Curto P, Simões I. Moonlighting in Rickettsiales: expanding virulence landscape. Trop Med Infect Dis. 2022;7(2):32.
5. Pokhrel A, Rayamajhee B, Khadka S, Thapa S, Kapali S, Pun SB, et al. Seroprevalence and clinical features of scrub typhus among febrile patients attending a referral hospital in Kathmandu. Nepal Trop Med Infect Dis. 2021;6(2):78.