Department of Internal Medicine, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
Department of Gastroenterology, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
JNMA J Nepal Med Assoc. 2022 Jun 1;60(250):573-576. doi: 10.31729/jnma.7275.
Abducens nerve palsies associated with infectious diseases are rare. Scrub typhus is an acute, febrile, infectious illness caused by Orientia tsutsugamushi carried out by vector mite zoonosis and is highly endemic in the so-called "tsutsugamushi triangle". The organism has been reported to be capable of entering the nervous system, causing meningitis and focal neurologic abnormalities. We report a 23 years old previously healthy girl who presented with fever, pain abdomen, vomiting and classical pathognomic black eschar mark on the right proximal medial calf region. After exclusion of other common infectious causes, scrub typhus serology immunoglobulin M was positive and was diagnosed with scrub typhus associated with unilateral abducens nerve palsy which responded to doxycycline therapy. On the background of strong clinical suspicion, we underline its significance in the interpretation of the serologic testing and its role in guiding the further treatment respectively.
abducens nerve palsy; case report; Orientia tsutsugamushi; scrub typhus; zoonoses.
与传染病相关的展神经麻痹较为罕见。恙虫病是一种由恙虫东方体引起的急性、发热性传染病，通过媒介恙螨的动物源性传染病流行，高度流行于所谓的“恙虫病三角区”。有报道称，该病原体能够进入神经系统，引起脑膜炎和局灶性神经异常。我们报告了一例 23 岁的既往健康女性，出现发热、腹痛、呕吐和右侧小腿近端内侧有典型的黑色焦痂斑。在排除其他常见感染原因后，恙虫病血清免疫球蛋白 M 呈阳性，诊断为恙虫病相关的单侧展神经麻痹，经多西环素治疗后有效。在强烈的临床怀疑背景下，我们分别强调了其在血清学检测解释中的意义及其在指导进一步治疗中的作用。
展神经麻痹；病例报告；恙虫东方体；恙虫病；动物源性传染病。
