Uncommon Manifestations of Scrub Typhus Encephalitis in Two Cases: Clinical and Magnetic Resonance Imaging Findings

Abstract

Scrub typhus causes systemic vasculitis characterized by the destruction of endothelial cells that line small blood vessels and inflammatory lesions caused by infiltrating leukocytes (1). It is a rickettsial disease caused by Orientia tsutsugamushi and is transmitted through chigger bites. Its prevalence is high in East Asia, Korea, and the western Pacific region (1). It involves multiple organs, and is characterized by a fever, headache, myalgia, rash, lymphadenopathy, eschar formation, pneumonia, and meningoencephalitis. Scrub typhus with central nervous system (CNS) involvement presents with various features from aseptic meningitis to meningoencephalitis (2). Cerebrospinal fluid (CSF) analysis generally shows pleocytosis, a normal level of glucose, and a mild increase in the protein level (1). The early diagnosis of scrub typhus with CNS involvement is important, as it can alter the patients’ prognoses and reduce mortality rates. Scrub typhus with CNS involvement is not rare and has been reported in several cases. However, to the best of our knowledge, scrub typhus encephalitis with extensive white matter involvement and subependymal enhancement are rarely described findings in the previous literature. Uncommon Manifestations of Scrub Typhus Encephalitis in Two Cases: Clinical and Magnetic Resonance Imaging Findings 흔하지 않은 소견을 보였던 두 증례의 쯔쯔가무시 뇌염: 임상적, 자기공명영상 소견