Concurrent Scrub Typhus and Cytomegalovirus Encephalitis in an Immunosuppressed Patient: A Rare Case Report
Vidhya N1, Durga Devi G2, Shenbaga Lalitha S3, Swetha N B4
Journal of Angiotherapy 6(1) 1-4 https://doi.org/10.25163/angiotherapy.61621772922221222
Submitted: 29 November 2021 Revised: 12 December 2021 Published: 05 January 2022
Abstract
Background: Scrub typhus, a zoonotic infection caused by Orientia tsutsugamushi, is highly endemic in South East Asia and has emerged as a significant public health concern due to increasing urbanization. The disease commonly presents with nonspecific symptoms such as fever, headache, and myalgia, but can lead to severe complications like encephalitis, particularly in immunocompromised patients. Concurrent infections, such as with cytomegalovirus (CMV), are rare but can complicate the clinical presentation and management. Methods: We present a case of a 53-year-old female with rheumatoid arthritis on immunosuppressive therapy who developed encephalitis. The patient was evaluated with a comprehensive diagnostic approach, including cerebrospinal fluid (CSF) analysis, serological testing, and brain imaging. Initial broad-spectrum antimicrobial therapy was started empirically, and further testing was performed to identify potential tropical infections. Results: CSF analysis revealed elevated protein levels and lymphocytic pleocytosis, suggesting a viral or rickettsial etiology. Radiological imaging indicated nonspecific findings of encephalitis. Serological testing confirmed a dual infection with scrub typhus and CMV. The patient’s treatment regimen was adjusted to include doxycycline for scrub typhus and valganciclovir for CMV encephalitis. Following the modified therapy, the patient showed significant clinical improvement, with normalization of her Glasgow Coma Scale (GCS) score and resolution of neurological symptoms. Conclusion: This case highlights the complexity of diagnosing and managing co-infections in immunocompromised patients presenting with encephalitis in endemic regions. It underscores the need for a high index of suspicion for multiple pathogens, comprehensive diagnostic evaluations, and prompt initiation of appropriate therapies to improve patient outcomes. Early recognition of atypical manifestations and co-infections is crucial in reducing morbidity and mortality associated with tropical infections.
Keywords: Scrub typhus, Cytomegalovirus (CMV) infection, Encephalitis, Immunosuppressive therapy, Co-infection
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