Department of Internal Medicine, GMCH, Chandigarh, India.
Radiodiagnosis, GMCH, Chandigarh, India.
BMJ Case Rep. 2023 Mar 29;16(3):e253350. doi: 10.1136/bcr-2022-253350.
Scrub typhus is a tropical febrile illness that mainly affects rural populations in tropical and subtropical countries. It can range in severity from a mild febrile illness to multisystem involvement. Systemic dysfunction often appears in the second week of sickness, and hepatic, renal and brain involvement are well documented. Although encephalitis is the most frequent neurological ailment, a wide range of unusual complications involving the central and peripheral nervous systems have been identified-however, concomitant multiaxial involvement of the central and peripheral nervous systems is unique. We report a case of a young man with serologically confirmed scrub typhus presenting with fever, eschar, altered sensorium and progressive quadriplegia with hyporeflexic deep tendon reflexes. MRI revealed changes suggestive of encephalitis, and there was evidence of axonopathy on nerve conduction studies. A diagnosis of scrub typhus encephalitis with concomitant Guillain-Barré syndrome was made. He received doxycycline and intravenous immunoglobulin therapy, in addition to supportive treatment.
恙虫病是一种热带发热疾病，主要影响热带和亚热带国家的农村人口。它的严重程度可从轻度发热疾病到多系统受累不等。全身功能障碍通常在发病的第二周出现，肝、肾和脑受累有充分的记录。尽管脑炎是最常见的神经系统疾病，但已经确定了一系列涉及中枢和周围神经系统的不常见并发症-然而，中枢和周围神经系统的同时多轴受累是独特的。我们报告了一例血清学证实的恙虫病年轻男性患者，表现为发热、焦痂、意识改变和进行性四肢瘫痪，伴有深腱反射减弱。MRI 显示提示脑炎的改变，神经传导研究有轴突病的证据。诊断为恙虫病脑炎合并格林-巴利综合征。除了支持治疗外，他还接受了多西环素和静脉注射免疫球蛋白治疗。
