A Rare Presentation of Scrub Typhus as Adem

Abstract

BACKGROUND A young male presented with fever, chills, neck rigidity, unsteadiness and abdominal pain. Patient had signs of chorea (hung-up reflex, exaggerated abdominal reflex), signs of meningoencephalitis (Kernig's positive, opsoclonus) generalised lymphadenopathy (involving cervical, inguinal & axillary regions)-tender & matted, eschar in right inguinal region, left UMN type of facial nerve palsy, signs of pyramidal tract (exaggerated deep tendon reflexes, right plantar extensor), signs of extrapyramidal tract (cog-wheel rigidity) and signs of cerebellar signs (hypotonia & stance and gait ataxia) were present bilaterally giving a picture of Acute Disseminated Encephalomyelitis (ADEM). ELISA for scrub typhus IgM was positive after ruling out malaria, dengue, leptospirosis, bacterial, viral and TB meningitis. ADEM is most rare and deadly presentation of Scrub typhus.