Abstract
We report a case of scrub typhus with multiple eschars and acute myocarditis with a new onset atrial fibrillation in a 53 year-old man. Eschar and cardiovascular complications of scrub typhus were discussed.
Highlights
Scrub typhus, called tsutsugamushi disease in Japan, is an acute febrile disease caused by orientia tsutsugamushi, an obligate intracellular gram-negattive bacteria
Routine blood tests showed a high white blood cell count (WBC), 11700/μL 4% atypical lymphocytes, elevated C-reactive Protein 6,3mg/dl, impaired liver function test; aspartate transaminase (AST), 54/μL alanine transaminase (ALT). 50/μL gammaglutamyl transpeptidase (γ-GTP) 61 /μL, lactate dehydrogenase (LDH) 537/μL creatine and platelet count were within normal range, Creatine-Kinase-MB (CK-MB) was 8.58ng/ml, cardiac troponin T was 0.033 ng/ml, and BNP was 178 pg/ml
Scrub typhus (ST) and Japanese Spotted Fever (JSF) are two main rickettsial infectious diseases in Japan and were classified as Category IV infectious diseases designated by the government ordinance in 1999
Summary
Called tsutsugamushi disease in Japan, is an acute febrile disease caused by orientia tsutsugamushi, an obligate intracellular gram-negattive bacteria. Human are infected accidently by the bite of the larva (chigger) harboring this bacteria. It is a serious health problem especially in the endemic regions known as tsutsugamushi triangle. Skin eruption and eschar are three major clinical symptoms of scrub typhus. Serious cardiovascular complications of scrub typhus were reported in the second-third week of the clinical course, as a result of delayed or untreated cases (mostly, in the pre-antibiotic era) complicated with fatal disseminated multiple organ failure. Morbiliform skin eruption over his chest and proximal aspects of the extremities were observed (Figure 3). Typical eschars at his right lower extremitity and left leg were found via a thorough skin check (Figure 4, Figure 5). Routine blood tests showed a high white blood cell count (WBC), 11700/μL 4% atypical lymphocytes, elevated C-reactive Protein 6,3mg/dl, impaired liver function test; aspartate transaminase (AST), 54/μL alanine transaminase (ALT). 50/μL gammaglutamyl transpeptidase (γ-GTP) 61 /μL, lactate dehydrogenase (LDH) 537/μL creatine and platelet count were within normal range, Creatine-Kinase-MB (CK-MB) was 8.58ng/ml (normal
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