An Unusual Manifestation of a Common Tropical Infection

Excerpt

To the Editor: A 15-y-old girl presented with acute onset high-grade fever associated with chills and rigor for 3 d. There was no history of cough, sore throat, burning micturition, pain abdomen, headache, or any other complaints. Examination revealed purple-colored, non-pruritic rashes over face, extremities, and trunk and an eschar over the right leg. Rest of the examination was normal. Investigations revealed thrombocytopenia and mildly elevated transaminase. Serological tests revealed high Orientia tsutsugamushi IgM antibody titers. Workups for other tropical illnesses were non-contributory. A diagnosis of scrub typhus was made and she was started on intravenous ceftriaxone. She became afebrile within 2 d, but after one week she developed holocranial, progressively worsening headache, vomiting, and blurring of vision. She had bilateral grade-4 papilledema and bilateral 6^th cranial nerve palsy. Magnetic resonance imaging of the brain showed tortuous and distended optic nerve sheaths and partial empty sella, without any parenchymal abnormalities. The cerebrospinal fluid examination was normal except elevated opening pressure (60 cm of water). A diagnosis of idiopathic intracranial hypertension (IIH) was made and she was started on acetazolamide. …