Scrub typhus with hemorrhagic stroke: a case report.

Area of Science:

• Infectious Diseases
• Neurology
• Critical Care Medicine

Background:

• Scrub typhus, caused by Orientia tsutsugamushi, infrequently involves the central nervous system.
• Intracerebral hemorrhage is a rare but serious complication of scrub typhus, particularly in endemic regions.
• The condition is often underdiagnosed, necessitating a high index of suspicion in patients with relevant clinical presentations.

Observation:

• A case report details a 40-year-old Nepali woman presenting with acute febrile illness, eschar, and sudden onset left-sided weakness.
• Diagnosis of scrub typhus was confirmed via serum IgM ELISA.
• Cranial imaging revealed a right frontotemporal hematoma, alongside pulmonary edema and multiple organ dysfunction syndrome.

Findings:

• The patient received mechanical ventilation and medical management including antibiotics, steroids, vasopressors, and antipyretics.
• The intracranial hemorrhage was managed conservatively.
• Neurological recovery was observed at the 6-month follow-up.

Implications:

• This case highlights the importance of considering scrub typhus in the differential diagnosis of neurological complications, including intracranial hemorrhage, in endemic areas.
• Prompt and appropriate therapeutic interventions are essential to mitigate potentially fatal outcomes.
• Physicians should maintain vigilance for uncommon presentations of scrub typhus to ensure timely and effective patient care.