Cranial polyneuropathy and triparesis due to mononeuritis multiplex in a case of scrub typhus

Authors

  • Sayonee Das Department of Medicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India
  • Ramiz Islam Department of Medicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India
  • Parvez Shahide Biswas Department of Medicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India
  • Kausik Munsi Department of Medicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India
  • Sagar Basu Department of Neuromedicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20210281

Keywords:

Scrub typhus, Cranial polyneuropathy, Triparesis, Mononeuritis multiplex

Abstract

Scrub typhus with neurological manifestations are often described. We present here unusual neurological manifestations in a patient with Scrub typhus. A 49 years old male presented with continued fever for the last 12 days along with headache and myalgia. He had left sided oculomotor nerve palsy along with palatal palsy and triparesis (except left upper limb) of lower motor neurone type. Electro-diagnostic studies showed asymmetric axonal sensorimotor neuropathies of multiple nerves in paretic limbs, suggestive of mononeuritis multiplex. Scrub typhus was diagnosed by the presence of IgM antibody in serum. He responded well with doxycycline therapy. This type of neurological presentation is extremely rare in scrub typhus and possibly has not been described earlier to the best of our knowledge.  

Author Biography

Sayonee Das, Department of Medicine, KPC Medical College and Hospital, Jadavpur. Kolkata, West Bengal, India

Resident, General Medicine

References

Brown GW. Scrub Typhus: Pathogenesis and clinical syndrome In Walker DH ed. Biology of Rickettsial Diseases. Vol I, Broca Raton, Florida: CRC Press 1988;93-100.

Mathai E, Rolain JM, Verghese GM et al. Outbreak of Scrub Typhus in South India during cooler months. Ann N.Y Acad Sci. 2003;990:359-64.

Mishra UK, J Kalita, VE Mani. Neurological manifestations of Scrub Typhus. JNNP. 2015;86:761-6

Sameer G, Anu M. Neurological manifestation of Scrub Typhus. Ann Ind Acad Neurol. 2013.16(1):131

Viswanathan S, Mathu V, Iqbal N. Scrub Typhus meningitis in South India- A retrospective study. PLOS one 2013;8:e66595

Noad KB, Haymaker W. The neurological features of Tsutsugamushi fever with special reference to deafness. Brain 1953;76:113-31

Kularatne SAM, Weerakoon KGAD, R.P.V.J Rajapakse RPVJ. A case of spotted fever with rickettsiosis with neurological manifestations in Sri Lanka. Int J of Infect Diseas. 2012;16;e514-7

Lee MS, Lee HS, Chang H. Scrub Typhus as a possible etiology of GBS: 2 cases. Ir J Med Sci. 2009;178:347-50

Ting KS, Lin JC, Chang MK. Brachial plexus Neuropathyassociated with Scrub Typhus: report of a case. J Formos Med Assoc. 1992;91:110-2

Lee KL, Lee JK, Yim YM et al. Acute transverse myelitis associated with Scrub typhus: Case report and review of literature. Diagn Microbial Infect Dis. 2008;60:237-9

Kang Ji-In, Kim DM, Lee J. Acute Sensorineural Hearing loss and severe otalgia due to Scrub typhus. Bio Med Cent Infect Dise. 2009;9:173

Hayakawa K, Oki M, Moriya Y. A case of scrub typhus with acalculus cholecystitis, aseptic meningitis and mononeuritis multiplex. J Medic Microbiol. 2012;61:291-4.

Pratibha Himral, Kailash Nath Sharma, Sushul Kudial et al. Scrub meningitis complicated by multiple cranial nerve palsy and cerebellitis. J Assoc Physic Ind. 2019;67:88-9

Jeong YJ, Kim S, Wook YD et al. Scrub typhus: Clinical, pathological and imaging findings. Radiographics. 2007;27;161-72

Lee SH, Jung SI, Park KH. GBS associated with Scrub typhus. Scan J Infect Dis. 2007;39:826-8.

Atul Phillips, Goutam Rani Agarwal, Vishal Mittal et al. Central and peripheral nervous system in Scrub typhus. Ann of IAN. 2018;21:318-21.

Kim JH, Lee SA, Ahn TB, Yoon SS, Park KC, Chang DI, et al. Polyneuropathy and cerebral infarction complicating scrub typhus. J Clinic Neurol. 2008;4(1):36-9.

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Published

2021-01-27

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Section

Case Reports