Abstract
<h3>Objective:</h3> We report a case of a young male with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium, and progressive quadriplegia to illustrate the neurological complications (central and peripheral) of scrub typhus. <h3>Background:</h3> A young male presented to the emergency with complaint of high-grade fever for the past 12 days and altered sensorium. From the 10th day of illness, he started complaining of worsening weakness in all four limbs. A black, crusted plaque with an erythematous halo, giving a ‘cigarette-burn’ appearance suggestive of an eschar, was noted on the right forearm. On neurological examination, the patient was disoriented to time and place. Neck rigidity was absent. Reduced power of 3/5 in upper limbs and 1/5 in lower limbs was noted. Deep Tendon Reflexes were absent, and plantars were mute. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> CSF analysis revealed no cells, mildly raised proteins (75 mg/dl), and normal glucose. CSF Grams staining, culture, India Ink preparation, and GeneXpert for Tuberculosis, was negative. Blood cultures were sterile. Scrub typhus IgM antibodies were detected using Enzyme-Linked-Immunosorbent-Assay (ELISA). Abdominal ultrasound revealed hepatomegaly. MRI-Brain revealed diffuse gyral swelling and hyperintensity on T2-weighted and FLAIR sequences involving bilateral lobes with no diffusion restriction, consistent with encephalitis. No abnormal post-contrast enhancement was noted. MRI-Spine was normal. Nerve Conduction Studies (NCS) were suggestive Acute Motor Axonal Neuropathy (AMAN) variant of Guillain-Barré-Syndrome (GBS). The patient received doxycycline. IVIG was added after NCS results. His condition gradually improved, and there was regaining of muscle strength in the following weeks with physiotherapy. <h3>Conclusions:</h3> Scrub typhus induced neurological complications are widely reported, with meningoencephalitis being the most common manifestation. However, PNS complications such as GBS are infrequent, and a high degree of clinical suspicion with prompt appropriate therapy and supportive care may prevent morbidity and mortality. <b>Disclosure:</b> Ms. Sood has nothing to disclose. Mr. Modi has nothing to disclose. Dr. Arora has nothing to disclose. Dr. Moudgil has nothing to disclose.
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