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Cerebral Venous Sinus Thrombosis Following Scrub Typhus Meningoencephalitis in a Pregnant Woman

Uttam Biswas1, Moisés León-Ruiz2, Ritwik Ghosh1

  • 1Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, India.

The Neurohospitalist
|September 23, 2024
PubMed
Abstract

Insights

Scrub typhus can cause serious neurological issues like meningoencephalitis, and rarely, cerebral venous sinus thrombosis (CVST). Early diagnosis and treatment, including anticoagulation for CVST, are crucial for pregnant women.

Area of Science:

  • Infectious Diseases
  • Neurology
  • Public Health

Background:

  • Scrub typhus, caused by Orientia tsutsugamushi, is a significant mite-borne zoonosis in the Asia Pacific.
  • Neurological complications, including meningoencephalitis and cerebral venous sinus thrombosis (CVST), are known manifestations.

Observation:

  • A unique case of CVST following scrub typhus meningoencephalitis in an 18-year-old pregnant woman is presented.
  • The patient exhibited fever, headache, neck stiffness, and altered sensorium, with laboratory findings of leukopenia and thrombocytopenia.
  • Cerebrospinal fluid analysis showed lymphocytic pleocytosis and elevated protein, with positive Orientia tsutsugamushi IgM.
  • Initial treatment with azithromycin led to improvement, but persistent headaches revealed CVST.

Findings:

  • The patient successfully responded to anticoagulation therapy with low molecular weight heparin for CVST.
  • The patient was discharged asymptomatic with a subsequent uneventful pregnancy and delivery.

Implications:

  • Cerebral venous sinus thrombosis should be considered in pregnant women with refractory scrub typhus meningoencephalitis.
  • Scrub typhus diagnosis is vital for febrile patients with acute neurological disorders in endemic areas, even without eschar or with normal neuroimaging.
  • Prompt antibiotic (doxycycline, azithromycin) and anticoagulation therapy can lead to favorable outcomes.
Keywords:
cerebral venous sinus thrombosismeningoencephalitispregnancyscrub typhus

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