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Neurological manifestations of scrub typhus: encephalitis and Guillain-Barré syndrome (GBS)
  1. Tanish Modi1,
  2. Tina Sood1,
  3. Sandeep Moudgil2 and
  4. Navneet Arora3
  1. 1Department of Internal Medicine, GMCH, Chandigarh, India
  2. 2Radiodiagnosis, GMCH, Chandigarh, India
  3. 3Department of Internal Medicine, PGIMER, Chandigarh, India
  1. Correspondence to Dr Navneet Arora; aroranavneet1045{at}


Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain involvement are well documented. Although encephalitis is the most frequent neurological ailment, a wide range of unusual complications involving the central and peripheral nervous systems have been identified—however, concomitant multiaxial involvement of the central and peripheral nervous systems is unique. We report a case of a young man with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium and progressive quadriplegia with hyporeflexic deep tendon reflexes. MRI revealed changes suggestive of encephalitis, and there was evidence of axonopathy on nerve conduction studies. A diagnosis of scrub typhus encephalitis with concomitant Guillain-Barré syndrome was made. He received doxycycline and intravenous immunoglobulin therapy, in addition to supportive treatment.

  • Infectious diseases
  • Neurology
  • Intensive care
  • Tropical medicine (infectious disease)

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  • Contributors TM: manuscript preparation. TS: manuscript preparation. SM: radiological legends, images and expert guidance. NA: writing the final draft, manuscript supervision, patient management, expert guidance.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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

  • © BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.