Context:
Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi. The disease can usually involve the lungs, heart, liver, spleen and brain through hematogenous dissemination. However, very rarely,
acute transverse myelitis in the spinal cord develops from
scrub typhus. We present a case of
acute transverse myelitis following
scrub typhus with a review of the literature. Findings: A 66-year-old male visited a hospital for general
myalgia, mild
headache, and
fever in October. He was noted to have thick, black papule skin on his abdomen, which was highly suggestive of
scrub typhus. To confirm the diagnosis, O. tsutsugamushi antibody titers were examined and detected highly in serum by an indirect fluorescence antibody assay.
Doxycycline, the standard treatment for
scrub typhus, was administered. However, after seven days of treatment, he rapidly developed weakness in the right leg,
paresthesia in both lower limbs, and voiding difficulty. Spinal magnetic resonance imaging (MRI) revealed lesions with high signal intensity involving the spinal cord at the thoracolumbar junction.
Paraparesis gradually improved following
steroid pulse
therapy for five days. At one-year follow-up, he could walk without
cane. Conclusions:Orientia tsutsugamushi causes
scrub typhus, which can affect not only the brain, but also the spinal cord. Although
acute transverse myelitis develops rarely from
scrub typhus, this should be considered as differential diagnosis in patients of
fever with neurological deficit in endemic areas.