Department of General Medicine, Government Medical College and Hospital, Chandigarh, India.
Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
BMJ Case Rep. 2020 Aug 27;13(8):e235790. doi: 10.1136/bcr-2020-235790.
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.
一位 19 岁女孩因发热、头痛、呕吐和嗜睡就诊。她有一级视乳头水肿和颈项强直，但无局灶性缺损或癫痫发作。脑脊液分析显示淋巴细胞增多症，蛋白稍有升高，葡萄糖正常。脑 MRI 显示左神经节-囊区在液体衰减反转恢复序列上呈高信号病变，伴有周边水肿和轻度中线移位。磁敏感加权成像显示该区域有出血。尽管恙虫病性脑膜脑炎并不少见，但对已知的脑膜炎病因进行了彻底检查，直到疾病第 10 天才延迟诊断为恙虫病。她接受了 2 周的多西环素治疗，临床和影像学均有明显改善。文献回顾显示，虽然恙虫病性脑膜脑炎并不少见，但脑 MRI 上如此不典型的病变则较为罕见。进行了连续影像学检查以记录疾病进展和治疗后的缓解情况。
