LIFE-THREATENING SCRUB TYPHUS WITH MENINGOENCEPHALITIS AND ACUTE RESPIRATORY-DISTRESS SYNDROME

A 21-year-old man presented with fever, rash, seizure, stiff neck and rapidly progressive bilateral pulmonary infiltrates. Cerebrospinal flu id (CSF) study revealed pleocytosis with predominant polymorphonuclear cells, and hypo-glycorrhachia. Status epilepticus occurred, followed by acute respiratory distress syndrome with respiratory failure. Blood and CSF cultures for bacteria were negative, but an indirect immunofl uorescence assay revealed a fourfold rise in antibody to Rickettsia ts utsugamushi in paired serum and a 1:2560 (+) IgM antibody titer. Sever e scrub typhus with meningoencephalitis and extensive pneumonitis was diagnosed. The patient survived after intravenous minocycline therapy and intensive care, including aggressive seizure control, supportive m echanical ventilation and avoidance of fluid overloading. He had a nea rly complete recovery. Practicing physicians in Taiwan should be aware of this reportable disease and its potentially serious complications if not promptly diagnosed and treated.