Hemophagocytic Lymphohistiocytosis: An Unusual Presentation of Scrub Typhus

Navaneethakrishnan Suganthan,Thaneswary Sooriyakumar,Menaka Mahakumara

doi:10.7759/cureus.9390

Abstract

Scrub typhus is an important etiological cause for acute undifferentiated febrile illness in the Asia-Pacific region, including Sri Lanka. It is a mite-borne disease caused by Orientia tsutsugamushi. Hemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive and potentially life-threatening hyperinflammatory syndrome rarely associated with scrub typhus. We herein describe a rare case of scrub typhus complicated by hemophagocytic lymphohistiocytosis in a 40-year-old previously healthy woman who presented with a history of an acute febrile illness. Following the observation of acute deterioration of hematological parameters despite the nature of the febrile illness, the rare association of hemophagocytic lymphohistiocytosis was considered, and this disease association was confirmed by fulfilling six out of eight of the diagnostic criteria of haemophagocytic lymphohistiocytosis. The patient made an uneventful recovery following treatment for the precipitating illness and with supportive care.

Highlights

Scrub typhus is a mite-borne infectious disease, caused by Orientia tsutsugamushi, which is an obligate intracellular bacteria and is endemic in the Asia-Pacific region
Hemophagocytic lymphohistiocytosis (HLH) is a rapidly progressive and potentially life-threatening hyperinflammatory syndrome rarely associated with scrub typhus
We describe a rare case of scrub typhus complicated by hemophagocytic lymphohistiocytosis in a 40-year-old previously healthy woman who presented with a history of an acute febrile illness

Summary

Introduction

Scrub typhus is a mite-borne infectious disease, caused by Orientia tsutsugamushi, which is an obligate intracellular bacteria and is endemic in the Asia-Pacific region. We describe a 40-year-old Sri Lankan woman presented with fever and pancytopenia She was diagnosed with scrub typhus fever complicated with hemophagocytic lymphohistiocytosis, which is a rare association. A 40-year-old, previously healthy Sri Lankan woman was presented with a history of fever of 12 days duration, which was associated with myalgia, polyarthralgia involving large and small joints, malaise, and other constitutional symptoms She did admit to a history of headaches mainly confined to frontal areas without photophobia or symptoms of rhinosinusitis. Her initial investigations revealed pancytopenia, with a white blood cell (WBC) count of 1940/mm 3, hemoglobin of 7.6 g/dL, and platelet count of 35,000/mm. As she was fulfilling six out of eight criteria for the diagnosis of hemophagocytic lymphohistiocytosis, the rare association of hemophagocytic syndrome triggered by scrub typhus was made. On review in two weeks, she was asymptomatic and her biochemical and hematological profiles were back to normal as a marker of uneventful recovery

Discussion

Conclusions

Disclosures