Korean J Infect Dis.  2002 Dec;34(6):391-395.

Use of High-dose Steroid in a Case of Scrub Typhus with Acutely Progressive Local Neurologic Symptoms

• Choi HC
• Wie SH
• Lee SY
• Kim SI
• Park SK
• Jung YJ
• Jung SL
• Jun JS
• Kang MW

Abstract

Scrub typhus, which is caused by Orientia tsutsugamushi, is systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in scrub typhus as in other rickettsial disease. A 54-year-old woman, who was receiving doxycycline under the diagnosis of scrub typhus, developed rapidly progressive neurologic symptoms. During the treatment, abnormal mental function, abnormal lateral gaze, paralysis in upper extremities and dysphasia occurred in the patient. To investigate CNS involvement in the patients, CSF profile (cell count and levels of protein and glucose) and brain radiologic image (brain CT, brain MRI) were concurrently examined. And ampicillin and high-dose steroid were empirically added to her treatment with doxycycline. With use of high-dose steroid, the initial neurologic symptoms such as restlessness and irritability and other disorders like abnormal lateral gaze and paralysis in upper extremities were recovered. And also any other neurologic sequelae did not appear. We could observe the clinical improvements of abnormal neurologic symptoms and signs after use of high-dose steroid in the Orientia tsutsugamushi infected patients. A further intensive study about the steroid therapy in Orientia tsutusgamushi infected patients with focal neurologic symptoms is required.

Keyword

Scrub typhus; Central nervous systems; High-dose steroid

MeSH Terms

Ampicillin
Aphasia
Brain
Central Nervous System
Diagnosis
Doxycycline
Female
Humans
Middle Aged
Neurologic Manifestations*
Orientia tsutsugamushi
Paralysis
Psychomotor Agitation
Scrub Typhus*
Upper Extremity
Vasculitis
Ampicillin
Doxycycline