BMJ Case Reports 2018; doi:10.1136/bcr-2018-224499
  • Unusual presentation of more common disease/injury

Meningitis due to scrub typhus: the importance of a differential diagnosis in an endemic area

  1. Buddha Basnyat2
  1. 1Department of Internal Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
  2. 2Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
  1. Correspondence to Professor Buddha Basnyat, buddhabasnyat{at}
  • Accepted 23 March 2018
  • Published 13 April 2018


A patient with fever and neck stiffness was treated as partially treated bacterial meningitis based on history, examination and cerebrospinal fluid analysis. After initial improvement with ceftriaxone, vancomycin and dexamethasone, symptoms recurred. Fever resolved promptly after treatment was started with doxycycline, when scrub typhus immunoglobulin M test came positive. Meningitis is a well-known complication of scrub typhus. However, scrub typhus is seldom considered in the differential diagnosis of meningitis in the Indian subcontinent. Early diagnosis and prompt institution of doxycycline therapy may lead to early cure of scrub typhus even when features of meningitis supervene. However, ceftriaxone which is commonly used to treat bacterial meningitis is suboptimal in the treatmenwgt36t of scrub typhus.


  • Contributors BB conceived the write up. SA wrote the first draft. All authors took care of the patient. All authors read and contributed to the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article