Dancing eyes and dancing feet in scrub typhus

Abstract

A 26-year-old male, presented to us with complaints of fever for five days and breathlessness for one day. During the hospital stay, he developed myoclonic jerks in all four limbs, head titubation, and saccadomania. Magnetic resonance imaging (MRI) of the brain ruled out structural lesions and cerebro spinal fluid (CSF) analysis ruled out meningo-encephalitis. Weil Felix was strongly positive, OX K titres were one in 640, and IgM for scrub typhus was positive. He was treated with doxycycline for one week. On follow-up he was found to be doing well with resolution of opsoclonus myoclonus.

Scrub typhus-associated opsoclonus: Clinical course and longitudinal outcomes in an Indian cohort

“…[ 7 18 20 ] The other two patients presented with opsomyoclonus. [ 19 21 ] Although reported individually and concomitantly in scrub typhus patients, cerebellar dysfunction and EPS have not been described previously in association with opsoclonus in this illness. [ 3 4 5 6 ] We demonstrate a clinical pattern, wherein scrub typhus-associated opsoclonus is frequently but not always accompanied by varying combinations of the above-mentioned neurological manifestations.…”

“…[ 26 ] Of the six patients with scrub typhus opsoclonus reported in literature, CSF analysis was performed in five. [ 7 19 20 21 ] The analysis was normal in two patients. [ 7 21 ] CSF albuminocytological dissociation was seen in two patients opsomyoclonus opsomyoclonus.…”

“…[ 7 19 20 21 ] The analysis was normal in two patients. [ 7 21 ] CSF albuminocytological dissociation was seen in two patients opsomyoclonus opsomyoclonus. Details of CSF analysis were unclear in the fifth patient.…”

“…[ 27 ] Among the six cases of scrub typhus opsoclonus reported in literature, MR imaging of the brain was performed in five patients and was normal in all. [ 7 19 20 21 ]…”

“…[ 11 12 13 14 15 16 17 ] Scrub typhus-associated opsoclonus is exceedingly rare with six reported cases in literature. [ 7 18 19 20 21 ] Given the paucity of clinical data, we set out to describe the clinical profile, laboratory features, and longitudinal outcomes, in a historical cohort of scrub typhus patients with opsoclonus.…”