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Abducens nerve palsy in a patient with scrub typhus: a case report
B Bhardwaj1, P Panda2, S Revannasiddaiah3
1Indira Gandhi Medical College, Department of Pulmonary Medicine and Tuberculosis Shimla, Himachal Pradesh, India: 171001.
Abstract:
Abducens nerve palsy is a known but rare complication of a few bacterial and viral infections like Mycoplasma pneumonia, cytomegalovirus, Epstein-Barr virus, Hanta virus, herpes zoster, and measles. Abducens nerve palsy due to scrub typhus is extremely rare and so far only one case has been reported in the literature. Scrub typhus is a febrile illness caused by rickettsia, Orientia tsutsugamushi, a gram negative intracellular obligate parasite which is endemic in Asia. This disease can present with wide range of clinical manifestations with involvement of any organ system, alone or in combination. Central nervous system involvement is very common and includes meningism, altered sensorium to focal neurological deficits. We present a rare manifestation of Scrub typhus in the form of sixth cranial nerve involvement which responded to the treatment with doxycycline.
Insights
Abducens nerve palsy is a rare complication of infections. This case highlights scrub typhus, a bacterial infection, causing sixth cranial nerve palsy, which successfully responded to doxycycline treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Abducens nerve palsy (sixth cranial nerve palsy) is a rare complication associated with various bacterial and viral infections.
- Scrub typhus, caused by Orientia tsutsugamushi, is an endemic febrile illness in Asia with diverse clinical manifestations, including central nervous system involvement.
Observation:
- This report details an extremely rare case of abducens nerve palsy as a primary manifestation of scrub typhus.
- The patient presented with isolated sixth cranial nerve palsy, a neurological deficit not commonly associated with this infection.
Findings:
- The diagnosis of scrub typhus was confirmed, and the patient's abducens nerve palsy showed a positive response to doxycycline therapy.
- This case underscores the broad spectrum of neurological complications possible with Orientia tsutsugamushi infection.
Implications:
- Early recognition and treatment of scrub typhus are crucial for managing its diverse clinical presentations, including rare neurological deficits.
- This case expands the understanding of Orientia tsutsugamushi's potential to cause cranial nerve palsies, emphasizing the need for considering scrub typhus in endemic areas with compatible symptoms.
- Doxycycline remains an effective treatment for scrub typhus, even in cases presenting with unusual neurological manifestations like abducens nerve palsy.
