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Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy
Ritwik Ghosh1, Subhrajyoti Biswas1, Arnab Mandal2
1Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, India.
Abstract:
Scrub typhus, an acute febrile infectious disease prevalent in the "Tsutsugamushi Triangle", is a mite-born rickettsial zoonosis, caused by Orientia tsutsugamushi. Although the clinical presentation is protean, it rarely causes abducens nerve palsy. We report a 14-year-old previously healthy Indian girl who presented with a recent onset right abducens nerve palsy and headache, but without fever and without the classic dermatological manifestation ("eschar") of the disease. After exclusion of common infectious, autoimmune, and neoplastic causes, she was finally diagnosed with scrub typhus associated with an abducens nerve palsy, which responded to doxycycline therapy.
Insights
Scrub typhus, a mite-borne infectious disease, rarely causes abducens nerve palsy. This case highlights a young girl diagnosed with scrub typhus presenting with abducens nerve palsy without typical symptoms.
Area of Science:
- Neurology
- Infectious Diseases
- Ophthalmology
Background:
- Scrub typhus is an acute febrile illness caused by *Orientia tsutsugamushi*, prevalent in the
- Tsutsugamushi Triangle
- and transmitted by mites.
- Abducens nerve palsy is an uncommon neurological complication of scrub typhus.
- Atypical presentations without fever or eschar can delay diagnosis.
Observation:
- A 14-year-old girl presented with acute onset right abducens nerve palsy and headache.
- She lacked fever and the characteristic eschar, common manifestations of scrub typhus.
- Other potential causes were ruled out.
Findings:
- The patient was diagnosed with scrub typhus associated with abducens nerve palsy.
- Treatment with doxycycline led to a positive clinical response.
Implications:
- This case expands the known clinical spectrum of scrub typhus.
- It emphasizes the importance of considering scrub typhus in patients with abducens nerve palsy, even without typical symptoms.
- Early diagnosis and treatment with doxycycline are crucial for favorable outcomes.
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