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Unusual presentation of more common disease/injury
Case report
Haemorrhagic encephalitis in the garb of scrub typhus
  1. Saurabh Gaba1,
  2. Swati Garg1,
  3. Monica Gupta1 and
  4. Rekha Gupta2
  1. 1Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
  2. 2Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
  1. Correspondence to Professor Monica Gupta; monicamanish2001{at}gmail.com

Abstract

A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.

  • infectious diseases
  • tropical medicine (infectious disease)
  • infection (neurology)

https://doi.org/10.1136/bcr-2020-235790

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    Footnotes

    • Contributors All the authors have provided substantial contributions in the clinical management of the case and literature review on the topic in question. SaGa and SwGa have drafted the manuscript and MG and RG have revised it critically for important intellectual content. All the authors have read the final version and approved it. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • 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 for publication Obtained.

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