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Granulomatous hepatitis associated with scrub typhus

R N Chien1, N J Liu, P Y Lin

  • 1Liver Unit, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.

Journal of Gastroenterology and Hepatology
|July 1, 1995
PubMed
Summary

Scrub typhus can cause liver injury mimicking acute hepatitis. Early antibiotic treatment led to complete recovery, highlighting its importance in differential diagnoses.

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Area of Science:

  • Infectious Diseases
  • Hepatology
  • Microbiology

Background:

  • Scrub typhus, a bacterial infection caused by Orientia tsutsugamushi, is prevalent in the Asia-Pacific region.
  • Typical presentations include fever, headache, and rash, but atypical manifestations can occur.
  • Hepatic involvement in scrub typhus is not commonly recognized as a primary feature.

Observation:

  • A 56-year-old patient presented with symptoms suggestive of acute hepatitis, including abnormal liver function tests and confirmed hepatic injury via biopsy.
  • The patient also exhibited classic signs of scrub typhus, such as fever, headache, eschar, lymphadenopathy, and lymphocytosis.
  • High Rickettsia tsutsugamushi immunofluorescence titres confirmed the scrub typhus diagnosis.

Findings:

  • The patient's hepatic injury was directly attributed to scrub typhus infection.

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  • Prompt antibiotic therapy resulted in a complete clinical recovery.
  • Liver biopsy findings were consistent with acute hepatitis, underscoring the unusual presentation.

    • Implications:

    • This case suggests scrub typhus should be considered in the differential diagnosis of acute hepatitis or granulomatous hepatitis.
    • Clinicians in endemic areas should maintain a high index of suspicion for scrub typhus presenting with liver abnormalities.
    • Recognizing this atypical presentation can lead to earlier diagnosis and effective treatment, preventing potential complications.