Scrub typhus: radiological and clinical findings in abdominopelvic involvement

Kim, Kun Yung; Song, Ji Soo; Park, Eun Hae; Jin, Gong Yong

doi:10.1007/s11604-016-0607-6

Cited by 5 publications

(8 citation statements)

References 36 publications

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“…This study reports a patient with spontaneous splenic rupture associated with scrub typhus and, for the first time, presents the corresponding gross and histopathologic findings. Abdominopelvic involvement is not uncommon in patients with scrub typhus [ 7 ]. However, splenic rupture and splenic infarction as splenic complications associated with scrub typhus have been reported as rare [ 1 , 7 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous splenic rupture associated with scrub typhus: a case report

Hwang,

Kim,

Han

et al. 2024

Infect Dis Poverty

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Background Scrub typhus, an acute febrile disease with mild to severe, life-threatening manifestations, potentially presents with a variety of complications, including pneumonia, acute respiratory distress syndrome, cardiac arrhythmias (such as atrial fibrillation), myocarditis, shock, peptic ulcer, gastrointestinal bleeding, meningitis, encephalitis, and renal failure. Of the various complications associated with scrub typhus, splenic rupture has rarely been reported, and its mechanisms are unknown. This study reports a case of scrub typhus-related spontaneous splenic rupture and identifies possible mechanisms through the gross and histopathologic findings. Case presentation A 78-year-old man presented to our emergency room with a 5-day history of fever and skin rash. On physical examination, eschar was observed on the left upper abdominal quadrant. The abdomen was not tender, and there was no history of trauma. The Orientia tsutsugamushi antibody titer using the indirect immunofluorescent antibody test was 1:640. On Day 6 of hospitalization, he complained of sudden-onset left upper abdominal quadrant pain and showed mental changes. His vital signs were a blood pressure of 70/40 mmHg, a heart rate pf 140 beats per min, and a respiratory rate of 20 breaths per min, with a temperature of 36.8 °C. There were no signs of gastrointestinal bleeding, such as hematemesis, melena, or hematochezia. Grey Turner's sign was suspected during an abdominal examination. Portable ultrasonography showed retroperitoneal bleeding, so an emergency exploratory laparotomy was performed, leading to a diagnosis of hemoperitoneum due to splenic rupture and a splenectomy. The patient had been taking oral doxycycline (100 mg twice daily) for 6 days; after surgery, this was discontinued, and intravenous azithromycin (500 mg daily) was administered. No arrhythmia associated with azithromycin was observed. However, renal failure with hemodialysis, persistent hyperbilirubinemia, and multiorgan failure occurred. The patient did not recover and died on the fifty-sixth day of hospitalization. Conclusions Clinicians should consider the possibility of splenic rupture in patients with scrub typhus who display sudden-onset abdominal pain and unstable vital signs. In addition, splenic capsular rupture and extra-capsular hemorrhage are thought to be caused by splenomegaly and capsular distention resulting from red blood cell congestion in the red pulp destroying the splenic sinus. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

“…Among the various scrub typhus-related complications, splenic involvement, such as splenic rupture or splenic infarction, has been reported as rare [ 7 ]. Two cases of splenic rupture associated with scrub typhus have been reported in MEDLINE, 1 in PubMed and 1 in KoreaMed [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous splenic rupture associated with scrub typhus: a case report

Hwang,

Kim,

Han

et al. 2024

Infect Dis Poverty

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“…The clinical features include fever (83.3%), myalgia (76.9%), maculopapular rash (46.2%), eschar (66.7%), upper respiratory and gastrointestinal symptoms noted in about 11.5% and neurological symptoms seen in about 2.6% of patients. 9 Due to wider manifestations, infection tends to be under diagnosed or wrongly diagnosed. The diagnosis is usually made with scrub IgM ELISA having a sensitivity of 86.5%.…”

Section: Case Reportmentioning

confidence: 99%

“…Other radiological manifestations commonly seen in scrub include ascites (53.8%), gallbladder thickening (29.5%), pleural effusion (30.8%) and splenic infarcts seen in about 3.8% of patients. 9 Most common infectious causes of splenic infarcts include malaria, babesiosis, while few of the uncommon causes include mycoplasma pneumonia, CMV, EBV, bartonella. It is also noticed in kala-azar and leptospirosis.…”

Section: Case Reportmentioning

confidence: 99%

An unusual manifestation of scrub typhus presenting with splenic infarct: a case report

Arora

Nawahirsha²,

Kumar³

et al. 2023

Int J Adv Med

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“…The 25 papers described larger cohorts of patients for a total of 2985 patients with rickettsial diseases, and among these patients, 487 (15.97%) suffered from pleural effusion. Only in 4 of these, molecular techniques were performed to achieve the etiological diagnosis [53][54][55]; the diagnosis was made by microscopic observation of morulae within the cytoplasm of polymorph-nucleate-cells only once [56]; in the other 23 case series, the diagnosis was made by serological assays [52,53,55,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73]. In the last 25 years in Europe, there was only one report of pleural effusion associated with a rickettsial disease.…”

Section: Pleural Effusionmentioning

confidence: 99%

Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy

et al. 2022

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Background: Motivated by a case finding of Mediterranean spotted fever (MSF) associated with atypical pneumonia and pleural effusion in which Rickettsia conorii subsp. israelensis was identified by molecular methods in the pleural fluid, we wanted to summarize the clinical presentations of rickettsiosis in Italy by systematic research and to make a systematic review of all the global cases of rickettsiosis associated with pleural effusion. Methods: For the literature search, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology was followed. We chose to select only the studies published in last 25 years and confirmed both with serological and molecular assays. Results: Human cases of rickettsiosis in Italy were reported in 48 papers describing 2831 patients with very different clinical presentations; the majority was MSF accounted to R. conorii and was reported in Sicily. Pleural effusion associated with infection with microorganisms belonging to Rickettsiales was described in 487 patients. It was rarely associated with microorganisms different from O. tsutsugamushi; also rarely, cases of scrub typhus were reported outside Southeast Asia and in the largest majority, the diagnosis was achieved with serology. Conclusions: MSF, especially when caused by R. conorii subsp. israelensis, may be a severe disease. A high index of suspicion is required to promptly start life-saving therapy. Pleural effusion and interstitial pneumonia may be part of the clinical picture of severe rickettsial disease and should not lead the physician away from this diagnosis

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Scrub typhus: radiological and clinical findings in abdominopelvic involvement

Cited by 5 publications

References 36 publications

Spontaneous splenic rupture associated with scrub typhus: a case report

Spontaneous splenic rupture associated with scrub typhus: a case report

An unusual manifestation of scrub typhus presenting with splenic infarct: a case report

Rickettsiosis with Pleural Effusion: A Systematic Review with a Focus on Rickettsiosis in Italy

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