Scrub typhus manifesting with Temporal lobe hemorrhage: a Case report

Abstract

Background: Tsutsugamushi disease, alternatively known as Scrub Typhus, is a natural focus disease caused by Rickettsia tsutsugamushi. Clinical manifestations include sudden onset, fever, eschar or ulceration at the bite site, lymphadenopathy, and rash. Moreover, severe scrub typhus can present with a variety of symptoms. Timely diagnosis and appropriate intervention are critically linked to the prognosis of scrub typhus. Case presentation: The patient, a 57-year-old woman, was admitted to our hospital with primary symptoms of fever and headache. Brain computed tomography (CT) scan revealed a hemorrhage in the temporal lobe, leading to her admission to our hospital's Department of Neurosurgery. Subsequently, the patient was transferred to the Intensive Care Unit (ICU) due to severe respiratory failure and hypotension. Ultimately, the clinical diagnosis of severe scrub typhus was established. Conclusion: Early diagnosis and timely intervention of scrub typhus are crucial for improving the disease's prognosis. Clinicians must heighten their awareness of scrub typhus to facilitate early detection and prompt treatment. The review of the disease progression in this case indicates that, in patients with scrub typhus, despite the absence of severe coagulopathy and DIC, the potential risk of cerebral hemorrhage should still be vigilantly monitored. Moreover, consideration should be given to the potential risk of scrub typhus infection in patients with cerebral hemorrhage and unexplained fever, especially in areas where scrub typhus is endemic.