A bstract Scrub typhus has reemerged with a different geographical distribution and varied clinical presentation like acute encephalitis syndrome (AES), which is a less known entity in scrub typhus. In this case series, we studied the clinical profile and outcome of eight patients who presented with AES and a positive scrub serology without any other identifiable cause of encephalopathy. All these patients had fever, altered sensorium, and nuchal rigidity, while seizures were present in six (75%) patients and papilledema in two (25%) patients. Complications like shock, pulmonary edema, and gastrointestinal (GI) bleed were observed in three (37%) patients. All patients except for one responded well to the treatment and recovered completely. Scrub typhus should be suspected early in patients presenting with AES. How to cite this article: Kaur P, Jain R, Kumar P, Randev S, Guglani V. Clinical Spectrum and Outcome of Acute Encephalitis Syndrome in Children with Scrub Typhus: A Series of Eight Cases from India. Indian J Crit Care Med 2020;24(9):885–887.

This case describes new onset mammary Paget disease arising in the background of Darier disease. Clinically and histologically, lesions of Darier disease can mask the lesions of mammary Paget disease. A high index of suspicion is necessary to diagnose Paget disease in a patient with Darier disease, for a potentially fatal disease could easily be missed.

A seven-year-old female child presented with fever for 3 days, oral ulcers and rash all over the body for one day. She was on sodium valproate at 20 mg/kg/day since a month in view of focal seizures. Baseline liver function tests (LFT) were normal prior to starting valproate. On admission, child had generalized exfoliating rash (Figure 1), jaundice and shock (blood pressure of 76/50 mm of Hg) requiring fluid resuscitation. She was treated with zinc, local paraffin application and glycerin mouth wash for oral ulcers. Sodium valproate was withdrawn and levetiracetam was started. Complete blood count revealed hemoglobin of 9.7 gm/dl, total leucocyte counts 10,000 cells/cumm (50% polymorphs, 40% lymphocytes and 6% eosinophils), platelet count 450,000 cells/cumm. Liver function tests (LFTs) were deranged (Table 1). Pancreatic function tests were also deranged with serum amylase of 162 IU/L and serum lipase of 448 IU/L. Ultrasound abdomen revealed hepatomegaly with increased gall bladder thickness. Serum creatinine was 0.4 mg/dl. IgM for dengue and scrub typhus, hepatitis A IgM, Hepatitis E IgM, malaria antigen test, HIV Elisa were negative. Prothrombin time was 17 sec and INR was 1.8 which were corrected after Vitamin K injection.