SAT-427 AKI IN TROPICS/PATIENT RETURNING FROM TROPICS -WHY EXPANDING OUR DIFFERENTIALS IS NEEDED!

Abstract

CASE REPORT People living in tropics have some endemic risk factors specific to the demographic region they reside in. A variety of causes are prevalent - including Malaria, Dengue Hemorrhagic Fever, Infectious Diarrhea, Leptospirosis, Snake Envenomation, and Scrub Typhus. We describe a case of Scrub Typhus with AKI. This particular case is interesting as it was from a cosmopolitan city, away from hilly areas where this rickettsial fever is more common. World Health Organisation (WHO) has recently warned about the potential of Scrub Typhus to cause widespread disease in tropics, deviating from the natural restriction to hilly areas to occurring in cities or towns. Scrub typhus is an important disease - frequently neglected. The annual estimate of cases is 1 million, while the population at risk, at 2 Billion is even huge, with the Tsutsugamoshi triangle extending from Japan in the east to Pakistan in the west and China to the north and Australia to the south. A 21-year-old male had presented with an 8-day history of low-grade fever, diarrhea, and oliguria. On evaluation, the patient was found to be febrile, dehydrated and in hypotension. He had icterus and tender inguinal lymphadenopathy. The patient remained anuric after rehydration despite recovering from hypotension. The patient received Hemodialysis as required. Patient was thoroughly investigated for etiology. Labs are depicted in tables uploaded together as pictures. Chest Radiograph : Normal Ultrasound of Abdomen and Pelvis:Mild Splenomegaly, Mild Ascites, Multiple Sub Centimetric Aorto-Iliac Lymph nodes. Minimal Bilateral Pleural Effusions. DIAGNOSIS: ENDEMIC ZOONOSIS SCRUB TYPHUS - WITH MULTI SYSTEM INVOLVEMENT- AKI, HEPATITIS, BICYTOPENIA. CONCLUSIONS: Scrub Typhus is thought to be a rare, endemic cause of AKI- prevalent in hilly and mountainous areas. The current case report points to an atypical presentation of the disease in a young male who had recently visited an urban garden, in the city of Hyderabad in southern India. This is due to the rapid expansion of cities extending into surrounding forest areas. The Eschar over skin which is pathognomonic- is absent in our case which had made the diagnosis difficult. Also, the presence of eschar is highly variable, is strain-specific and the dark complexion of skin makes the identification of eschar difficult. The discovery of new vectors of the pathogen, by Tilak et al (Schoengastiella ligula -northeast India) in India and Lee et al (Euschoengastia koreaensis in South Korea), marks an important breakthrough in the understanding of the epidemiology of the disease. REFERENCES: 1. Incidence, risk factors and clinical outcomes of acute kidney injury associated with scrub typhus: a retrospective study of 510 consecutive patients in South Korea (2001–2013) Hwang K, et al. BMJ Open 2017;7:e013882. doi:10.1136/bmjopen-2016-013882