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Scrub Typhus Masquerading As Infectious Mononucleosis: A Case Report.

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Scrub typhus, a tick-borne illness caused by Orientia tsutsugamushi, can present without a rash. Early diagnosis and treatment with tetracycline are crucial for recovery, even with atypical symptoms.

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Scrub typhus is a significant public health concern in endemic areas, caused by Orientia tsutsugamushi.
  • The disease typically manifests with fever, rash, and eschar, but presentations can vary.
  • Early diagnosis is vital for effective treatment and preventing complications.

Observation:

  • A 74-year-old man presented with nonspecific symptoms mimicking cholangitis and cytomegalovirus (CMV) infection.
  • The patient initially lacked the characteristic rash and eschar of scrub typhus.
  • An eschar was identified later, leading to correct diagnosis and treatment.

Findings:

  • Serology confirmed scrub typhus with elevated Orientia tsutsugamushi IgM and IgG levels.
  • Treatment with tetracycline resulted in complete recovery.
  • Initial positive CMV-IgM results were deemed insignificant upon further testing.

Implications:

  • This case highlights the diverse clinical presentations of scrub typhus, emphasizing the need for vigilance.
  • A thorough physical examination is crucial for identifying subtle signs like eschars.
  • Maintaining clinical suspicion for scrub typhus in febrile patients from endemic regions is essential for accurate diagnosis.