HY Ng, KW Tsui, KH Ma, KY Liu

Abstract

Background: Scrub typhus is a notifiable disease in Hong Kong. The common presentation of scrub typhus can be non-specific such as pyrexia of unknown origin. Neurological manifestation is relatively uncommon, especially for acute disseminated encephalomyelitis in the globe. Findings: A 33-month-old girl presented with prolonged fever, confused consciousness, bilateral lower limb weakness, and urinary incontinence. Cranial and Spinal magnetic resonance imaging showed T2 hyper-intense signals over bilateral thalamus and long segments of spinal cord. Both clinically and radiologically suggested acute disseminated encephalomyelitis. Subsequent workup revealed significant four-fold increment in Orientia tsutsugamushi antibody level. She was given a course of methylprednisolone and intravenous immunoglobulins for disseminated encephalomyelitis and a course of doxycycline for scrub typhus infection. She achieved full recovery afterwards. Conclusion: As acute disseminated encephalomyelitis remains a diagnosis of exclusion and is commonly post-infection related. It is important to stay vigilant in screening for underlying atypical infection in refractory clinical presentation.