Abstract
Murine typhus is an endemic infectious disease caused by Rickettsia typhi and is transmitted by fleas. It typically causes a mild illness with symptoms of fever, rash, headache, chills, and non-specific gastrointestinal complaints. However, there have been no reported cases in the literature of murine typhus infection causing symptoms of acute psychosis and disseminated intravascular coagulation (DIC).A 30-year-old female with a history of gastric bypass and chronic pain syndrome presented to the emergency department with altered mental state and fever. She developed vivid visual hallucinations, DIC, and hypoxia with pulmonary opacities, ultimately requiring intubation. Magnetic resonance imaging (MRI) showed leptomeningeal enhancement with unremarkable cerebrospinal fluid (CSF) studies. Serum murine typhus serology came back positive. Doxycycline therapy was initiated, which resulted in complete patient recovery.This case shows that murine typhus infection may present with acute psychosis and can mimic DIC, leading to diagnostic confusion. MRI sequences may show leptomeningeal enhancement, which has never been reported before in patients with typhus. Early neurological imaging using advanced MRI sequences for patients presenting with altered sensorium, visual hallucinations, and symptoms similar to thrombotic thrombocytopenic purpura (TTP) may help with early diagnosis, decreased hospital stay, and better prognosis.
Highlights
Murine typhus is a febrile illness caused by Rickettsia typhi
Murine typhus can present with acute delirium and encephalitis, there have been no reported cases of murine typhus presenting with acute encephalopathy, psychosis, leptomeningeal enhancement, vivid visual hallucinations, and disseminated intravascular coagulation
We present a case of a patient with murine typhus presenting with fever, altered mental status, thrombocytopenia, and vivid hallucinations
Summary
Murine typhus is a febrile illness caused by Rickettsia typhi. Rickettsia species are gramnegative, obligate intracellular bacilli. How to cite this article Pervaiz A M, Tariq R, Bangash S A, et al (April 13, 2019) Murine Typhus Presenting with Acute Psychosis and Disseminated Intravascular Coagulation: A Case Report. Murine typhus can present with acute delirium and encephalitis, there have been no reported cases of murine typhus presenting with acute encephalopathy, psychosis, leptomeningeal enhancement, vivid visual hallucinations, and disseminated intravascular coagulation. There has been one reported case of Scrub typhus presenting with visual hallucinations in India in 2015. There was another study conducted in the 1950s, which reported psychiatric abnormalities in typhus patients, including hallucinations, but none mentioned meningeal disease. We present a case of a patient with murine typhus presenting with fever, altered mental status, thrombocytopenia, and vivid hallucinations. Typhus serologies came back positive and doxycycline was initiated, which led to rapid and complete resolution of symptoms, and the patient recovered
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