An unusual presentation of scrub typhus with lateral rectus palsy in a child

Authors

  • Jeslin Joshy Chiramel Department of Paediatrics, Aster CMI Hospital, Bengaluru, Karnataka, India
  • Parimala V. Thirumalesh Department of Paediatrics, Aster CMI Hospital, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20230446

Keywords:

Scrub typhus, Orientia tsutsugamushi, Meningitis, Lateral rectus palsy

Abstract

Scrub typhus, an acute febrile infectious disease prevalent in the “Tsutsugamushi triangle”, is a mite-born rickettsial zoonosis, caused by Orientia tsutsugamushi. Although the clinical presentation is protean, it rarely causes abducens nerve palsy. We report a 13-year-old previously healthy Indian boy who presented with a recent onset right abducens nerve palsy, headache and fever but without the classic dermatological manifestation (“eschar”) of the disease. After exclusion of common infectious and other causes, he was finally diagnosed with scrub typhus associated with an abducens nerve palsy, which responded to doxycycline therapy.

References

Jiang J, Richards AL. Scrub Typhus: No Longer Restricted to the Tsutsugamushi Triangle. Trop Med Infect Dis. 2018;3(1):11.

Choi WY, Lee SY, Kwon HY, Im JH, Durey A, Baek JH et al. A Case of Scrub Typhus Complicated by Adult Respiratory Distress Syndrome and Successful Management with Extracorporeal Membrane Oxygenation. Am J Trop Med Hyg. 2016;95(3):554-7.

Chauhan A, Jandial A, Mishra K, Sandal R. Scrub typhus and lateral rectus palsy: an uncommon presentation of a common illness. BMJ Case Rep. 2021;14(5):e240882.

Ete T, Mishra J, Barman B, Mondal S, Sivam RK. Scrub Typhus Presenting with Bilateral Lateral Rectus Palsy in A Female. J Clin Diagn Res. 2016;10(4):OD16-7.

Ozair A, Kumar V, Himanshu D, Bhat V. A rare etiology behind isolated lateral rectus palsy: Scrub typhus. J Family Med Prim Care. 2020;9(5):2538-40.

Ghosh R, Biswas S, Mandal A, De K, Bandyopadhyay S, Sardar SS et al. Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy. Neuro-Ophthalmol. 2022;46(2):99-103.

Lee YH, Yun YJ, Jeong SH. Isolated abducens nerve palsy in a patient with scrub typhus. J Am Asso Pediatr Ophthalmol Strabismus. 2010;14(5):460-1.

Bhardwaj B, Panda P, Revannasiddaiah S, Bhardwaj H. Abducens Nerve Palsy in a Patient with Scrub Typhus: A. Trop Biomed. 2013;30(4):706-9.

Dixit J, Jadon RS, Ray A, Ranjan P, Vikram NK, Sood R. Scrub typhus with bilateral sensorineural hearing loss: A unique case report. J Vector Borne Dis. 2020;57:101-3.

Arumilli MNLN, Revappa KB, Rao K, Rangappa P, Jacob I. A rare case of rickettsial fever with isolated third cranial nerve palsy causing hemophagocytic lymphohistiocytosis. Indian J Case Rep. 2021;7(9):409-11.

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Published

2023-02-23

Issue

Section

Case Reports