Reversible high-grade AV block in a patient with scrub typhus

Area of Science:

• Cardiology
• Infectious Diseases

Background:

• Febrile illnesses can present with diverse symptoms.
• Cardiac conduction abnormalities require thorough etiological investigation.

Purpose of the Study:

• To report a case of scrub typhus presenting with complete heart block.
• To emphasize the importance of considering scrub typhus in febrile illnesses with cardiac involvement.

Main Methods:

• Case presentation of a man in his late 30s.
• Clinical examination, ECG, and laboratory tests including cardiac markers.
• Management with temporary transvenous pacemaker and intravenous doxycycline.

Main Results:

• Patient presented with prolonged fever, syncope, hypotension, bradycardia, and thigh eschars.
• ECG revealed complete heart block with a wide QRS escape rhythm.
• Diagnosis of scrub typhus confirmed with elevated cardiac markers.
• Symptoms resolved rapidly, and cardiac conduction normalized within 48 hours of treatment.

Conclusions:

• Scrub typhus should be considered in the differential diagnosis of febrile illnesses with conduction abnormalities.
• Early diagnosis and appropriate management of scrub typhus can prevent severe cardiac complications.
• This case underscores the potential cardiac manifestations of scrub typhus, particularly in endemic regions.