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Acute transverse myelitis following scrub typhus: A case report and review of the literature.
J Spinal Cord Med. 2020 07; 43(4):548-551.JS

Abstract

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.

Authors+Show Affiliations

Department of Neurosurgery, Chonnam National University Hospital and Medical School, Biomedical Research Institute, Gwangju, Korea.Department of Neurosurgery, Chonnam National University Hospital and Medical School, Biomedical Research Institute, Gwangju, Korea.Department of Neurosurgery, Chonnam National University Hospital and Medical School, Biomedical Research Institute, Gwangju, Korea.Department of Neurosurgery, Chonnam National University Hospital and Medical School, Biomedical Research Institute, Gwangju, Korea.Department of Neurosurgery, Dong-Ah Hospital, Gwangju, Korea.Department of Neurosurgery, Chonnam National University Hospital and Medical School, Biomedical Research Institute, Gwangju, Korea.

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

29350608

Citation

Ryu, Hyun-Seung, et al. "Acute Transverse Myelitis Following Scrub Typhus: a Case Report and Review of the Literature." The Journal of Spinal Cord Medicine, vol. 43, no. 4, 2020, pp. 548-551.
Ryu HS, Moon BJ, Park JY, et al. Acute transverse myelitis following scrub typhus: A case report and review of the literature. J Spinal Cord Med. 2020;43(4):548-551.
Ryu, H. S., Moon, B. J., Park, J. Y., Kim, S. D., Seo, S. K., & Lee, J. K. (2020). Acute transverse myelitis following scrub typhus: A case report and review of the literature. The Journal of Spinal Cord Medicine, 43(4), 548-551. https://doi.org/10.1080/10790268.2017.1420538
Ryu HS, et al. Acute Transverse Myelitis Following Scrub Typhus: a Case Report and Review of the Literature. J Spinal Cord Med. 2020;43(4):548-551. PubMed PMID: 29350608.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute transverse myelitis following scrub typhus: A case report and review of the literature. AU - Ryu,Hyun-Seung, AU - Moon,Bong Ju, AU - Park,Jae-Young, AU - Kim,Sang-Deok, AU - Seo,Seung-Kwon, AU - Lee,Jung-Kil, Y1 - 2018/01/19/ PY - 2018/1/20/pubmed PY - 2021/10/29/medline PY - 2018/1/20/entrez KW - Doxycycline KW - Rickettsia KW - Scrub typhus KW - Transverse myelitis KW - Tsutsugamushi SP - 548 EP - 551 JF - The journal of spinal cord medicine JO - J Spinal Cord Med VL - 43 IS - 4 N2 - 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. SN - 2045-7723 UR - https://www.unboundmedicine.com/medline/citation/29350608/Acute_transverse_myelitis_following_scrub_typhus:_A_case_report_and_review_of_the_literature_ DB - PRIME DP - Unbound Medicine ER -