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Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report.
BMC Res Notes. 2017 Oct 06; 10(1):496.BR

Abstract

BACKGROUND

Scrub typhus is an acute infectious illness caused by Orientia tsutsugamushi. It is endemic to a part of the world known as the "tsutsugamushi triangle". Humans are accidental hosts in this zoonotic disease. About a third of patients admitted with scrub typhus have evidence of multi-organ dysfunction. Multi-organ dysfunction secondary to scrub typhus carries a high mortality rate.

CASE PRESENTATION

We report a 65-year old lady who was admitted in a Tertiary Care Center in the state of Kerala in India, with 7 day history of fever, myalgia and reduced urine output. Head to foot examination revealed the presence of an eschar on her chest. One week prior to the onset of her illness she had gone trekking through a hilly forest area. She was clinically suspected to have scrub typhus, which was later confirmed with laboratory tests. She developed multi-organ dysfunction syndrome secondary to this illness. Though there was an improvement in the multi-organ dysfunction, thrombocytopenia alone failed to improve. Bone marrow study was done which was suggestive of immune thrombocytopenia. Patient was given a course of steroids with which the thrombocytopenia improved.

CONCLUSION

Failure of platelet count to normalize even after there has been a general improvement of other markers of multi-organ dysfunction in scrub typhus should prompt the clinician to consider other potential causes of thrombocytopenia. An unusual finding as this calls for further research to understand the molecular mechanisms behind such an event. Further, considering the close similarity in clinical presentation of several tropical illnesses, meticulous history taking and a detailed physical examination needs to be emphasized.

Authors+Show Affiliations

M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. abyliz@rediffmail.com. Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. abyliz@rediffmail.com.M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. Department of Anaesthesiology, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India. Department of Medicine, M.O.S.C Medical College & Hospital, Ernakulam District, Kolenchery, Kerala, 682311, India.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

28985768

Citation

Ittyachen, Abraham M., et al. "Immune Thrombocytopenia With Multi-organ Dysfunction Syndrome as a Rare Presentation of Scrub Typhus: a Case Report." BMC Research Notes, vol. 10, no. 1, 2017, p. 496.
Ittyachen AM, Abraham SP, Krishnamoorthy S, et al. Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report. BMC Res Notes. 2017;10(1):496.
Ittyachen, A. M., Abraham, S. P., Krishnamoorthy, S., Vijayan, A., & Kokkat, J. (2017). Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report. BMC Research Notes, 10(1), 496. https://doi.org/10.1186/s13104-017-2826-z
Ittyachen AM, et al. Immune Thrombocytopenia With Multi-organ Dysfunction Syndrome as a Rare Presentation of Scrub Typhus: a Case Report. BMC Res Notes. 2017 Oct 6;10(1):496. PubMed PMID: 28985768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immune thrombocytopenia with multi-organ dysfunction syndrome as a rare presentation of scrub typhus: a case report. AU - Ittyachen,Abraham M, AU - Abraham,Saramma P, AU - Krishnamoorthy,Smitha, AU - Vijayan,Anuroopa, AU - Kokkat,Jayamohan, Y1 - 2017/10/06/ PY - 2017/01/20/received PY - 2017/09/30/accepted PY - 2017/10/8/entrez PY - 2017/10/8/pubmed PY - 2018/5/29/medline KW - Case report KW - Immune thrombocytopenia KW - Multi-organ dysfunction syndrome KW - Scrub typhus SP - 496 EP - 496 JF - BMC research notes JO - BMC Res Notes VL - 10 IS - 1 N2 - BACKGROUND: Scrub typhus is an acute infectious illness caused by Orientia tsutsugamushi. It is endemic to a part of the world known as the "tsutsugamushi triangle". Humans are accidental hosts in this zoonotic disease. About a third of patients admitted with scrub typhus have evidence of multi-organ dysfunction. Multi-organ dysfunction secondary to scrub typhus carries a high mortality rate. CASE PRESENTATION: We report a 65-year old lady who was admitted in a Tertiary Care Center in the state of Kerala in India, with 7 day history of fever, myalgia and reduced urine output. Head to foot examination revealed the presence of an eschar on her chest. One week prior to the onset of her illness she had gone trekking through a hilly forest area. She was clinically suspected to have scrub typhus, which was later confirmed with laboratory tests. She developed multi-organ dysfunction syndrome secondary to this illness. Though there was an improvement in the multi-organ dysfunction, thrombocytopenia alone failed to improve. Bone marrow study was done which was suggestive of immune thrombocytopenia. Patient was given a course of steroids with which the thrombocytopenia improved. CONCLUSION: Failure of platelet count to normalize even after there has been a general improvement of other markers of multi-organ dysfunction in scrub typhus should prompt the clinician to consider other potential causes of thrombocytopenia. An unusual finding as this calls for further research to understand the molecular mechanisms behind such an event. Further, considering the close similarity in clinical presentation of several tropical illnesses, meticulous history taking and a detailed physical examination needs to be emphasized. SN - 1756-0500 UR - https://www.unboundmedicine.com/medline/citation/28985768/Immune_thrombocytopenia_with_multi_organ_dysfunction_syndrome_as_a_rare_presentation_of_scrub_typhus:_a_case_report_ DB - PRIME DP - Unbound Medicine ER -