Unilateral Multifocal Brain Lesions in Scrub Typhus Encephalitis: A Distinctive Presentation

Research Objectives: To present a case of scrub typhus encephalitis accompanied by unilateral limb paralysis and abnormal brain MRI findings.

Design: A case report

Setting: Hospitalized care

Participants: A 75-year-old woman developed fever and decreased consciousness after a recent trip. Initially hospitalized elsewhere with suspected scrub typhus, she presented with unstable vital signs and signs of sepsis-associated encephalopathy. Her condition worsened, showing left-sided neurological symptoms, including eye deviation and limb movements.

Interventions: Examination showed a reduced response to pain and a positive Babinski sign on the left side, indicating a possible lesion in the right hemisphere. Analysis of cerebrospinal fluid revealed increased white blood cells and protein levels, along with a decreased glucose ratio. Brain MRI displayed multiple lesions with restricted diffusion in the right temporo-occipital lobe and basal ganglia, accompanied by meningeal enhancement. The EEG recorded frequent slow-wave activity but did not show any epileptiform discharges.

Main Outcome Measures: Tests confirmed the diagnosis of scrub typhus encephalitis with positive serological results. The patient received treatment with doxycycline and azithromycin, along with supportive care such as sedation, dialysis, and mechanical ventilation. Once stabilized, her condition improved, and she was moved to a general ward for rehabilitation of her left limb paralysis.

Results: The presence of focal brain lesions, while not commonly reported in other cases, suggests that Orientia tsutsugamushi may selectively affect the central nervous system, leading to a range of neurological symptoms.

Conclusions: This case highlights the importance of considering central nervous system involvement in scrub typhus, especially in critically ill patients, and underscores the potential for unusual complications such as unilateral paralysis.

Author(s) Disclosures: All authors listed on this abstract declare that there are no conflicts of interest or financial relationships that could be perceived as a bias in this presentation. We have no relevant affiliations or financial involvements with any organizations that could influence the content of our presentation.