Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Kaohsiung J Med Sci. 2011 Dec;27(12):573-6. doi: 10.1016/j.kjms.2011.10.003. Epub 2011 Nov 25.
Scrub typhus is widely distributed across the Asia-Pacific region, Taiwan included. The clinical manifestations and complications of scrub typhus vary and the illness ranges in severity from mild to fatal. The etiology of facial nerve palsy varies and infectious agents have been associated with this condition. Rickettsiae species have, however, rarely been reported as the causative agents. We report the case of a 49-year-old man who had fever, malaise, headache, oligouria and tea-colored urine. Bilateral pneumonitis, acute renal failure, acalculous cholecystitis and aseptic meningitis were diagnosed after a series of examinations. The patient recovered after doxycycline treatment but he developed bilateral facial palsy during the convalescent phase, which improved after the administration of a steroid. The diagnosis of infection with Orientia tsutsugamushi was confirmed by the Taiwan Center of Disease Control and the tests for Leptospira, Rickettsia typhi and Coxiella burnetii were all negative. This case indicates that scrub typhus needs to be included in the differential diagnoses of cases of bilateral and simultaneous facial nerve palsy, particularly in areas where the disease is endemic.
恙虫病广泛分布于亚太地区，包括中国台湾。恙虫病的临床表现和并发症多种多样，病情从轻到重不等。面神经麻痹的病因多种多样，与感染因子有关。然而，立克次体很少被报道为致病因子。我们报告了一例 49 岁男性，发热、乏力、头痛、少尿和茶色尿。一系列检查后诊断为双侧肺炎、急性肾衰竭、胆石症和无菌性脑膜炎。患者经多西环素治疗后康复，但在恢复期出现双侧面瘫，给予类固醇治疗后有所改善。经台湾疾病管制中心确认诊断为恙虫病感染，钩端螺旋体、伤寒立克次体和贝纳柯克斯体检测均为阴性。本病例表明，在双侧和同时发生面神经麻痹的病例中，需要考虑恙虫病的鉴别诊断，特别是在该病流行的地区。
