Arai Motomi, Nakamura Asuka, Shichi Daisuke
Department of Neurology, Seirei Mikatahara General Hospital.
Rinsho Shinkeigaku. 2007 Jun;47(6):362-4.
A 64-year-old man visited our clinic with a 9-day history of headache and fever. He had frequent, severe, electric shock-like pain in his left eye, forehead, and scalp. The body temperature was 37.1 degrees. Cranial nerve functions were intact. Limb weakness and stiff neck were absent. There were injection of the conjunctiva, a red rash on the trunk, and an eschar in the axilla. Abnormal laboratory findings included AST 40 IU, ALT 44 IU, CRP 16.0 mg/dl, WBC 11,090/microl, and proteinuria. CT scan was unremarkable. The cerebrospinal fluid (CSF) showed 2 polymorphs/microl, 6 lymphocytes/microl, 65 mg/dl of glucose, and 42 mg/dl of protein. A diagnosis of scrub typhus was made. Treatment with minocycline brought about prompt disappearance of the fever and dramatic clinical improvement. Increased antibody titers confirmed the diagnosis. Although almost all patients present with high fever and severe headache, only a small number of patients have CSF pleocytosis. The present case illustrates that pain in scrub typhus is, on rare occasions, indistinguishable from trigeminal neuralgia. Neurologists should have a high index of suspicion in patients with fever and headache during the epidemic season and should be familiar with the systemic symptoms and signs.
一名64岁男性因头痛和发热9天前来我院就诊。他左眼、前额和头皮频繁出现剧烈的电击样疼痛。体温为37.1度。颅神经功能完好。无肢体无力和颈项强直。有结膜充血、躯干红色皮疹及腋窝焦痂。实验室检查异常包括谷草转氨酶40 IU、谷丙转氨酶44 IU、C反应蛋白16.0 mg/dl、白细胞11,090/微升及蛋白尿。CT扫描无异常。脑脊液显示每微升有2个多形核白细胞、6个淋巴细胞、葡萄糖65 mg/dl及蛋白42 mg/dl。诊断为恙虫病。用米诺环素治疗后发热迅速消退，临床症状显著改善。抗体滴度升高证实了诊断。尽管几乎所有患者都有高热和严重头痛，但只有少数患者脑脊液有细胞增多。本例说明恙虫病的疼痛在极少数情况下与三叉神经痛难以区分。神经科医生在流行季节对发热和头痛患者应高度怀疑，并应熟悉全身症状和体征。
