Pal Grewal Tejinder, Kumar H Mohan
Department of Internal Medicine, Post Graduate Institute of Medical Education and Medical Research, Chandigarh, India.
IDCases. 2021 Mar 26;24:e01086. doi: 10.1016/j.idcr.2021.e01086. eCollection 2021.
A 60-year-old female presented to the emergency room with fever and myalgias for four days and shortness of breath for two days. On clinical examination, she was tachypneic and blood oxygen saturation of 86 % on room air. There was an eschar of size 1 × 1 cm on the left infraclavicular area (Fig. 1). Chest examination showed bilateral interscapular crepitations. CXR showed bilateral lower zone infiltrates. Scrub typhus IgM was found to be positive by rapid diagnostic kit test, Eschar biopsy was also positive for scrub typhus by Polymerase Chain Reaction. The patient was started on doxycycline, clinically improved and discharged after ten days. Presence of eschars is considered pathognomonic of scrub typhus. Incidence of eschar varies widely from 7 % to 97 %. The main reason for low detection is eschars being missed on routine clinical examination as these are painless lesions consisting of a black scab, with an erythematous halo and minimal edema. Eschars are usually found over the covered areas of the body, such as the groin, axilla, chest, and lower back which appears a few days after at chigger-bite sites, even before the disease manifestation. This case emphasizes the importance of thorough clinical examination to look for eschar and early diagnosis and initiation of treatment while routine laboratory assays are awaited.
一名60岁女性因发热和肌痛四天、气短两天就诊于急诊室。临床检查发现，她呼吸急促，在室内空气中血氧饱和度为86%。左锁骨下区域有一个1×1厘米大小的焦痂（图1）。胸部检查显示双侧肩胛间有捻发音。胸部X光显示双侧下肺野浸润。快速诊断试剂盒检测发现恙虫病IgM呈阳性，焦痂活检经聚合酶链反应检测恙虫病也呈阳性。患者开始使用多西环素治疗，临床症状改善，十天后出院。焦痂的存在被认为是恙虫病的特征性表现。焦痂的发生率差异很大，从7%到97%不等。检测率低的主要原因是在常规临床检查中遗漏了焦痂，因为这些是无痛性病变，由黑色痂皮组成，有红斑晕且水肿轻微。焦痂通常出现在身体的遮盖部位，如腹股沟、腋窝、胸部和下背部，在恙螨叮咬部位几天后出现，甚至在疾病表现出来之前。该病例强调了在等待常规实验室检测结果时，进行全面临床检查以寻找焦痂、早期诊断和开始治疗的重要性。
