Massive small bowel bleeding caused by scrub typhus in Korea

Area of Science:

• Infectious Diseases
• Gastroenterology
• Pathology

Background:

• Scrub typhus, caused by Orientia tsutsugamushi, is a significant public health concern in Asia and the Pacific.
• While typically presenting with fever, rash, and eschar, scrub typhus can manifest with diverse and severe complications.
• Gastrointestinal involvement is uncommon, with limited pathological evidence in existing literature.

Purpose of the Study:

• To report the first pathologically confirmed case of small bowel vasculitis secondary to scrub typhus.
• To emphasize the potential for severe gastrointestinal hemorrhage in scrub typhus infections.
• To highlight the diagnostic challenges and management of this rare complication.

Main Methods:

• A 79-year-old male patient presented with symptoms consistent with scrub typhus.
• Diagnosis was confirmed by elevated serum tsutsugamushi antibodies; doxycycline treatment was initiated.
• Colonoscopy revealed small bowel ulcerations with hemorrhage, leading to surgical resection and pathological examination.

Main Results:

• The patient developed hematochezia (bloody stools) five days after initiating doxycycline treatment.
• Colonoscopy identified multiple ulcerated lesions in the small bowel.
• Pathological analysis confirmed vasculitis as the cause of the ulcerations, directly linked to scrub typhus infection.

Conclusions:

• This case provides the first pathological confirmation of small bowel involvement in scrub typhus.
• Scrub typhus can cause severe gastrointestinal complications, including vasculitis and hemorrhage, requiring prompt recognition and management.
• Physicians should consider scrub typhus in the differential diagnosis for patients presenting with unexplained gastrointestinal bleeding, especially in endemic areas.