Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus?

Area of Science:

• Ophthalmology
• Infectious Diseases
• Microbiology

Background:

• Scrub typhus, a zoonotic disease caused by Orientia tsutsugamushi, can present with diverse clinical manifestations.
• Ocular involvement in scrub typhus is uncommon but can lead to significant visual impairment.

Observation:

• A 15-year-old female presented with headache, blurred vision, and conjunctival hemorrhage, progressing to bilateral disc edema.
• Initial investigations showed mild thrombocytopenia and lymphocytosis, with normal cerebrospinal fluid (CSF) analysis.
• Positive IgM titre for scrub typhus confirmed the diagnosis.

Findings:

• The patient received oral doxycycline, leading to complete resolution of subconjunctival hemorrhage and disc edema within three weeks.
• Best-corrected visual acuity improved from 20/40 to 20/20 in both eyes post-treatment.
• No recurrence of symptoms was noted during a six-month follow-up period.

Implications:

• This case highlights the importance of considering scrub typhus in the differential diagnosis of febrile illnesses with ocular findings, even in atypical presentations.
• Early diagnosis and treatment with doxycycline are crucial for favorable visual outcomes in scrub typhus-associated ophthalmopathy.
• Further research into the spectrum and management of ocular manifestations of scrub typhus is warranted.