ACUTE DISSEMINATED ENCEPHALOMYELITIS AS A COMPLICATION OF SCRUB TYPHUS

Abstract

Scrub typhus is an acute febrile illness usually characterized by eschar, lymphadenopathy, multisystem involvement caused by Orientia tsutsugamushi. Scrub typhus as a cause of acute disseminated encephalomyelitis (ADEM) is extremely rare. This is a case report of a 40 years old female presenting with sudden onset altered sensorium, bilateral lower limb weakness with difculty in walking, irrelevant speech, urinary and bowel retention since two days, high grade intermittent fever associated with headache and multiple episodes of vomiting for past one week. Cerebro spinal uid study showed lymphocytic pleocytosis with mildly increased protein. MRI brain showed multifocal encephalitis & MRI spine revealed demyelination at spinal cord suggestive of ADEM. Paired CSF & serum scrub typhus IgM ELISA was found to be positive. She was ultimately diagnosed as a case of scrub typhus complicated with ADEM. After treatment with doxycycline and methylprednisolone patient improved dramatically without any residual neurological decit during discharge. This case report highlights that scrub typhus should be included in the differentials in patients presenting withADEM for early diagnosis and treatment in order to reduce mortality and morbidity.