Acute severe monarthritis: a rare manifestation of scrub typhus

Handattu, Koushik; Yellanthoor, Ramesh Bhat; Konda, Kalyan Chakravarthy; Kini, Sandesh

doi:10.1136/bcr-2018-227002

Cited by 4 publications

(6 citation statements)

References 4 publications

(9 reference statements)

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“… 2 The incidence of eschar, maculopapular rashes, lymphadenopathy, gastrointestinal symptoms, hepatomegaly, and splenomegaly have been described in 7-68%, 30%, 23-93%, 40%, 66%, and 33% of cases, respectively. 1 Eschar at the site of mite bite, though previously considered classical, may not always be observed. Increased vascular permeability and hypoperfusion of the affected tissue, lead to various complications like pneumonitis, encephalitis, acute kidney injury, myocarditis, and septic shock.…”

Section: Discussionmentioning

confidence: 98%

“…Scrub typhus is a known cause of fever of unknown origin. 1 But not much is known about the pathophysiology and virulence factors of this infection. It has been described to proliferate within small vessels of various organs after escaping the body's normal defenses.…”

Section: Discussionmentioning

confidence: 99%

“…Perivascular inflammatory changes caused by the exaggerated Th1 response result in a variety of manifestations. 1 , 2 Symptoms overlap with other tropical illnesses like malaria, dengue, brucellosis, and leptospirosis. Deranged hepatic enzymes, renal functions, and thrombocytopenia are seen in most patients with leukopenia or leukocytosis.…”

Section: Introductionmentioning

confidence: 99%

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HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report

Khatri

Upadhyaya²,

Kandel³

et al. 2023

J Nepal Med Assoc

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Scrub typhus is common in rural Nepal's southern plains, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common manifestations of the condition including eschar might further complicate this problem and may result in treatment delays. We report a case of scrub typhus with the primary presentation of reactive monoarthritis of the left hip joint in a 19-year-old male who presented with difficulty in walking, and pain over the left hip joint. Ultrasonography of the left hip and thigh showed features of synovitis and iliopsoas bursitis. After a meticulous workup, a diagnosis of human leukocyte antigen B27 negative reactive monoarthritis of the left hip joint triggered by scrub typhus infection was made and the patient was treated with doxycycline. Delays in treatment and the rate of complications can be prevented with high clinical suspicion and awareness of the atypical presentation of the condition.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report

Khatri

Upadhyaya²,

Kandel³

et al. 2023

J Nepal Med Assoc

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“…5 It is usually self-limited and non-deforming. A robust literature review for scrub typhus with arthritis in children has yielded three case reports, of a 10-year-old girl from Northern India with ankle arthritis, 6 a 4-year-old boy from South India with hip arthritis, 7 and an adolescent male with massive small bowel haemorrhage and polyarthritis. 8 Our patient had arthritis in proximal interphalangeal and metacarpophalangeal joints with a typical eschar that was diagnostic of scrub typhus and scrub IgM ELISA confirmed this.…”

Section: Discussionmentioning

confidence: 99%

Small joint polyarthritis – An unusual presentation of scrub typhus in a child

et al. 2021

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Scrub typhus is a common Rickettsial infection which is endemic in tropical regions. It is characterised by fever, eschar, thrombocytopenia, lymphadenopathy and organomegaly. Scrub typhus has significant morbidity and mortality owing to its multisystemic involvement. Non-inflammatory polyarthritis of small joints is an uncommon presentation in paediatric scrub typhus. We discuss a five-year-old boy who presented with fever, small joint polyarthritis, hepatosplenomegaly and pathognomonic eschar with positive scrub IgM ELISA. Arthritis resolved completely with doxycycline therapy without any deformity.

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“…As in every disease, scrub typhus can have some peculiar manifestations. There have been previous case studies reporting features of hemophagocytic syndrome, 1 epididymoorchitis, 2 acute severe monoarthritis, 3 and Guillain Barre syndrome. 4 In this case report, we present a patient who developed a rare cutaneous vasculitis in setting of Orientia tsutsugamushi infection with good response to doxycycline.…”

Section: Introductionmentioning

confidence: 99%

Leukocytoclastic Vasculitis

Vasireddy¹,

Pai²,

Shetty³

et al. 2023

Sultan Qaboos Univ Med J

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Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus among other acute febrile illnesses present with prodromal symptoms of fever, malaise, myalgia, anorexia followed by a distinct maculopapular rash, hepatosplenomegaly, and lymphadenopathy. In this case report, we present a patient who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil Felix test, a diagnostic titer of 1:640 against OX-K was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with Doxycycline and showed a drastic improvement in his symptoms. Keywords: Scrub Typhus, Rickettsia; Vasculitis; Doxycycline.

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Acute severe monarthritis: a rare manifestation of scrub typhus

Cited by 4 publications

References 4 publications

HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report

HLA-B27 Negative Reactive Monoarthritis of the Hip Joint Triggered by Scrub Typhus: A Case Report

Small joint polyarthritis – An unusual presentation of scrub typhus in a child

Leukocytoclastic Vasculitis

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