Acute fulminant myocarditis as a rare manifestation in complicated scrub typhus: A case report

Abstract

Scrub typhus or Tsutsugamushi disease is a febrile illness caused by bacteria of the family Rickettsiaceae and named Orientia Tsutsugamushi. Severe complications such as acute respiratory distress syndrome (ARDS), encephalitis, interstitial pneumonia, acute renal failure, acute hepatic failure and acute myocarditis may manifest. Fulminant scrub typhus myocarditis can lead to cardiogenic shock and cardiac arrest. Though myocarditis has been described as one of the rare manifestations of this infection, early detection of scrub typhus myocarditis is crucial before patients develop cardiogenic shock. Recovery depends on the prompt administration of hemodynamic support and appropriate antibiotics. We are presenting a case of acute fulminant myocarditis in complicated scrub typhus in a young female known case of atrial septal defect who was previously asymptomatic and not on any therapy for the same prior to admission. She was diagnosed by Enzyme-linked immunosorbent assay scrub typhus serology and 2D Echocardiography (mild mitral and tricuspid regurgitation with right ventricle systolic pressure = 25 mmHg + right atrial pressure and global hypokinesia of left ventricle with an ejection fraction of 25%) and responded very well to the administration of Doxycycline and other supportive treatments.