J Korean Med Sci.  2000 Jun;15(3):343-345. 10.3346/jkms.2000.15.3.343.

Acute respiratory distress syndrome associated with scrub typhus: diffuse alveolar damage without pulmonary vasculitis

• Park JS
• Jee YK
• Lee KY
• Kim KY
• Myong NH
• Seo PW

• KMID: 1128635
• DOI: http://doi.org/10.3346/jkms.2000.15.3.343

Abstract

Pathologic findings of scrub typhus have been characterized by vasculitis of the microvasculature of the involved organ resulting from a direct invasion by Orientia tsutsugamushi. We experienced a case of acute respiratory distress syndrome (ARDS) associated with scrub typhus. The case was proven by eschar and high titer of serum IgM antibody (positive at 1:1280). Open lung biopsy showed diffuse alveolar damage (DAD) in the organizing stage without evidence of vasculitis. Immunofluorescent antibody staining and polymerase chain reaction for O. tsutsugamushi failed to demonstrate the organism in the lung tissue. The patient expired due to progressive respiratory failure despite doxycycline therapy. Immunologic mechanism, without direct invasion of the organism, may participate in the pathogenesis of ARDS associated with scrub typhus.

Keyword

Scrub Typhus; Respiratory Distress Syndrome; Adult

MeSH Terms

Acute Disease
Aged
Case Report
Fatal Outcome
Female
Human
Infant, Newborn
Pulmonary Alveoli/pathology
Pulmonary Alveoli/injuries
Respiratory Distress Syndrome/physiopathology
Respiratory Distress Syndrome/pathology
Respiratory Distress Syndrome/immunology
Respiratory Distress Syndrome/complications*
Scrub Typhus/physiopathology
Scrub Typhus/pathology
Scrub Typhus/immunology
Scrub Typhus/complications*
Vasculitis