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Misdiagnosed murine typhus in a patient with multiple cerebral infarctions and hemorrhage: a case report
Ziqi Xu1, Xiongchao Zhu2, Qunying Lu3
1Department of Neurology, The First Affiliated Hospital of the College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China. zyxuziqi@zju.edu.cn.
Background:
Rickettsias cause a wide spectrum of tick-, flea-, or mite-borne infections. Rickettsial infections have no classical manifestations and can often lead to encephalitis, which can be fatal if improperly diagnosed.
Case Presentation:
A 74-year-old male farmer was admitted to the hospital with fevers and a headache that had lasted for 10 days, followed by 4 days of unconsciousness, and his condition continued to deteriorate. Images showed multiple acute lesions in the brain stem, and bilateral cerebral and cerebellar hemispheres. He was finally diagnosed with endemic typhus and treated with antibiotics that resulted in improvement.
Conclusion:
The present report describes a patient with a rickettsial infection and subsequent deterioration to coma because of an initial misdiagnosis. Because of the similarity to other infectious diseases, physicians should be more vigilant towards the history and radiologic results to ensure early detection and avoid complications which may prove to be fatal.
Insights
Rickettsial infections, like endemic typhus, can cause severe encephalitis and coma if misdiagnosed. Early detection through vigilant history taking and imaging is crucial for timely antibiotic treatment and preventing fatal outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Medical Diagnostics
Background:
- Rickettsial infections are vector-borne diseases with non-specific symptoms.
- Encephalitis is a potential severe complication of rickettsial infections.
- Delayed diagnosis of rickettsial infections can lead to fatal outcomes.
Observation:
- A 74-year-old male farmer presented with prolonged fever, headache, and subsequent unconsciousness.
- Brain imaging revealed multiple acute lesions in the brainstem, cerebrum, and cerebellum.
- The patient's deteriorating condition suggested a serious central nervous system insult.
Findings:
- The patient was diagnosed with endemic typhus, a rickettsial infection.
- Antibiotic treatment led to significant clinical improvement.
- Initial misdiagnosis contributed to the patient's severe neurological deterioration.
Implications:
- Physicians must maintain a high index of suspicion for rickettsial infections in patients with encephalitis.
- Thorough patient history and radiological findings are critical for early and accurate diagnosis.
- Prompt treatment of rickettsial encephalitis can prevent severe complications and mortality.
