Scrub Typhus-Induced Serious Gastric Ulcer Bleeding

Abstract

A 67-year-old woman presented with melena and general weakness. Upper gastrointestinal (GI) endoscopy revealed multiple ulcers and projectile bleeding in the stomach. She also complained of a 10-day history of a fever and was diagnosed with scrub typhus based on a positive result of the eschar polymerase chain reaction (PCR) testing. She fully recovered with endoscopic hemostasis, and administration of minocycline and omeprazole. In a patient with GI manifestations, scrub typhus, a condition with pathologically systemic vasculitis, should be considered in the possible background in endemic areas. The eschar PCR testing is a rapid and useful diagnostic tool to identify a specific strain.

Neuritis and Gastrointestinal Hemorrhage in Scrub Typhus Patients

“…The result of the peripheral blood test at the time of her initial admission revealed a white blood cell count of 16,530/mm 3 (89.6% neutrophils). Moreover, the hemoglobin count was 10.9 g/dL, and the platelet count was 307,000/mm 3 . Other relevant data from the peripheral blood test included the following: prothrombin time, 10.8 seconds; international normalized ratio, 0.97; activated partial thromboplastin time, 25.7 seconds; fibrinogen level, 160 mg/dL (reference range = 200-400 mg/dL); fibrinogen degradation products, 30.4 μg/mL (reference range = 0-5.0 μg/mL); and D-dimer level, 2,228 ng/mL (reference range = 0-255 ng/mL).…”

“…1 Gastrointestinal (GI) bleeding is not an uncommon complication in scrub typhus patients, with reported cases of gastric ulcer bleeding and small bowel bleeding. 2,3 However, to date, reports of histopathological findings of gastric ulcer bleeding in scrub typhus patients through stomach tissue examination have been nearly non-existent.…”

Masqueraders Around Disaster: Clinical Features of Scrub Typhus in Fukushima, Japan

“…Category 2 included 2 cases of Karp JP-1 characterized by acute gastric bleeding [ 16 ] and Karp-related strain [ 14 ] with DIC complicated by hypovolemic shock. The 1 fatal case was caused by infection with the serotype Kuroki [ 13 ].…”

Case Report: A Fatal Case of Scrub Typhus Complicated by Heatstroke

“…12 The L. pallidummediated serotype Karp is regarded as "the summer type "(otherwise from spring to autumn) of scrub typhus which is the fatal serotype. 13 Conversely, Irie/Kawasaki or Hirano/ Kuroki, the L. scutellare-mediated serotypes, is "the autumn type" of scrub typhus, which produces the so-called "November fever." 14 To our knowledge, this is the first fatality report of the scrub typhus serotype Hirano/Kuroki.…”