A case report of scrub typhus complicated with myocarditis and rhabdomyolysis

Abstract

BackgroundScrub typhus is a zoonotic disease caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium. Myocarditis and rhabdomyolysis are rare complications of scrub typhus.Case presentationWe report a case of scrub typhus, which was simultaneously complicated with myocarditis and rhabdomyolysis. A 54-year-old woman presented to our hospital with myalgia in the upper and lower limbs, oedema and a fever of 7 days’ duration. We confirmed the diagnosis of scrub typhus complicated with myocarditis by pericardial fluid analysis and cardiac magnetic resonance imaging results. The pericardial fluid showed characteristics of an exudate, an elevated immunofluorescence assay (IFA) IgG titer of 1:2048 and a positive 16S rRNA qPCR result. We also diagnosed rhabdomyolysis by the patient’s presenting symptoms, elevated muscle enzyme levels and bone scan results.ConclusionWe report for the first time a case of scrub typhus complicated with both myocarditis and rhabdomyolysis, the causative agent of which was the Boryong genotype of O. tsutsugamushi.

Case Report: Fulminant Myocarditis Successfully Treated With Extracorporeal Membrane Oxygenation in Ikeda Strain Orientia tsutsugamushi Infection

“…These differences in reported incidence and impact on the clinical course of myocarditis in scrub typhus also might reflect variable severity of myocarditis itself. The severity or course of myocarditis seems to be ranged from mild one ( 13 , 14 ) to fulminant one like ours and cases reported by only one study ( 8 ). In addition, the nature of scrub typhus itself with possible multi-organ involvement in complicated cases might mask the fulminant nature of myocarditis in scrub typhus.…”

Neurological Facets of Scrub Typhus

“…Approximately 20%–25% of patients with scrub typhus suffer from neurological complications, making this an important part of the clinical constellation. [ 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 ...…”

“…In one other case report, myalgias and high CPK levels were associated with rhabdomyolysis and in another report, severe myocarditis accompanied muscle involvement. [ 82 84 ] Both patients showed complete resolution with doxycycline alone.…”

A Case of Scrub Typhus with Multiple Eschars and New-Onset Atrial Fibrillation

“…The inflammation may be focal and this technique is invasive in hemodynamically unstable patients. Cardiac magnetic resonance (Cardiac MRI) enables clinicians to access cardiac function indirectly, and also provide assistance in directing myocardial biopsy to appropriate locations [7].…”