Haemorrhagic encephalitis in the garb of scrub typhus.
Saurabh GabaSwati GargMonica GuptaRekha GuptaPublished in: BMJ case reports (2020)
A 19-year-old girl presented with fever, headache, vomiting and drowsiness. She had grade 1 papilloedema and neck rigidity but no focal deficits or seizures. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis, slightly elevated protein and normal glucose. MRI of the brain showed a hyperintense lesion in left ganglio-capsular region on the fluid attenuation inversion recovery sequence with perilesional oedema and mild midline shift. Haemorrhage was seen in the region on susceptibility weighted imaging . The patient was thoroughly investigated for known causes of meningoencephalitis, but the diagnosis of scrub typhus was delayed till the 10th day of illness. She was treated with doxycycline for 2 weeks and had marked improvement, both clinically and radiologically. Literature review has revealed that although meningoencephalitis in scrub typhus is not uncommon, such atypical lesions on brain MRI are a rarity. Serial imaging was performed to document the disease progression and resolution on treatment.
Keyphrases
- contrast enhanced
- magnetic resonance imaging
- high resolution
- cerebrospinal fluid
- case report
- resting state
- white matter
- magnetic resonance
- traumatic brain injury
- diffusion weighted imaging
- single cell
- computed tomography
- functional connectivity
- type diabetes
- skeletal muscle
- mass spectrometry
- metabolic syndrome
- blood brain barrier
- adipose tissue
- blood pressure
- insulin resistance
- newly diagnosed
- binding protein
- replacement therapy
- small molecule
- chemotherapy induced
- smoking cessation