Hemorrhagic Transformation of Scrub Typhus Encephalitis: A Rare Entity

Abstract

Central nervous system (CNS) involvement of scrub typhus infection is well known. Most CNS involvement of scrub typhus infection present as meningitis or encephalitis. We report on a patient suffering from hemorrhagic transformation of intracranial lesions caused by Orientia tsutsugamushi. A 53-year-old female farmer who was infected by scrub typhus was treated with doxycycline and recovered from the systemic illness. However, headache persisted. Brain radiologic studies revealed acute intracranial hemorrhage and enhancing lesion, which implied a CNS involvement. Hemorrhagic transformation of encephalitis by scrub typhus is very rare complication and to our best knowledge, this is the first report of hemorrhagic transformation of scrub typhus encephalitis. Clinician should consider the possibility of hemorrhagic transformation of encephalitis in cases of scrub typhus infection.

Scrub typhus manifesting with intracerebral hemorrhage: Case report and review of literature

“…We here present a case of scrub typhus (ST) manifesting with a large intracerebral hemorrhage, of which, to the best of our knowledge, only nine cases have been reported in the English language worldwide. [ 1 2 3 4 5 6 7 8 ] Most of these were secondary to deranged coagulation profile, disseminated intravascular coagulation (DIC) and/or hemophagocytic lymphohistiocytosis (HLH), which were absent in this case.…”

“…Its diverse clinical presentations, lack of diagnostic testing in most rural areas, and low index of suspicion are the likely causes of its usual delayed diagnosis. [ 2 4 ] The latter cause is perhaps courtesy of its rapid rise due to which a considerable number of clinicians lack awareness of the same. Additionally, ST can lead to a host of neuropsychiatric manifestations, if untreated, including meningitis, encephalitis, cerebellitis, cranial nerve palsies, demyelination, subdural hematomas etc.…”

Uncommon Manifestations of Scrub Typhus Encephalitis in Two Cases: Clinical and Magnetic Resonance Imaging Findings

“…Scrub typhus causes systemic vasculitis characterized by the destruction of endothelial cells that line small blood vessels and inflammatory lesions caused by infiltrating leukocytes (1). It is a rickettsial disease caused by Orientia tsutsugamushi and is transmitted through chigger bites.…”

“…It is a rickettsial disease caused by Orientia tsutsugamushi and is transmitted through chigger bites. Its prevalence is high in East Asia, Korea, and the western Pacific region (1). It involves multiple organs, and is characterized by a fever, headache, myalgia, rash, lymphadenopathy, eschar formation, pneumonia, and meningoencephalitis.…”

“…Scrub typhus with central nervous system (CNS) involvement presents with various features from aseptic meningitis to meningoencephalitis (2). Cerebrospinal fluid (CSF) analysis generally shows pleocytosis, a normal level of glucose, and a mild increase in the protein level (1). The early diagnosis of scrub typhus with CNS involvement is important, as it can alter the patients' prognoses and reduce mortality rates.…”