Unveiling the unseen: generalized myoclonus status and MODS in scrub typhus, a case report and literature review

Orientia tsutsugamushi, the causative agent of scrub typhus, poses a significant public health threat across the Asia-Pacific region. Clinical manifestations of scrub typhus vary widely, delays in treatment are associated with high mortality, whereas prompt and appropriate antimicrobial therapy, typically with doxycycline or suitable alternatives, can significantly reduce fatality rates. Early diagnosis and effective treatment are thus critical for patient outcomes. Here, we present a rare case of scrub typhus featuring generalized myoclonus status and multiple organ dysfunction syndrome (MODS).

A 72-year-old Asian male with a history of schizophrenia presented to our hospital with a one-week history of persistent, involuntary, and synchronous jerkings involving the extremities with preserved consciousness for one week. Physical examination revealed an eschar on the left scrotal region. Definitive diagnosis was confirmed via targeted next-generation sequencing (tNGS) of alveolar lavage fluid, which detected Orientia tsutsugamushi. The patient was diagnosed with scrub typhus, accompanied by generalized myoclonus status and MODS.

Clinicians in endemic regions should consider scrub typhus in the differential diagnosis of patients presenting with acute febrile illness of unknown origin and neurological abnormalities. A thorough and detailed physical examination, timely and effective treatment are essential for curing the disease.