Zhou XL, Ye QL, Chen JQ, Li W, Dong HJ. Manifestation of acute peritonitis and pneumonedema in scrub typhus without eschar: A case report. World J Clin Cases 2021; 9(23): 6900-6906 [PMID: 34447840 DOI: 10.12998/wjcc.v9.i23.6900]
Corresponding Author of This Article
Hao-Jian Dong, MD, PhD, Chief Physician, Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), No. 2 Hongyang Road, Jinwan District, Zhuhai 519000, Guangdong Province, China. donghaojian@sina.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2021; 9(23): 6900-6906 Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6900
Manifestation of acute peritonitis and pneumonedema in scrub typhus without eschar: A case report
Xiu-Ling Zhou, Qing-Long Ye, Jia-Qian Chen, Wei Li, Hao-Jian Dong
Xiu-Ling Zhou, Qing-Long Ye, Jia-Qian Chen, Wei Li, Hao-Jian Dong, Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), Zhuhai 519000, Guangdong Province, China
Author contributions: Zhou XL wrote the manuscript; Ye QL contributed to data collection and analysis; Li W and Chen JQ helped perform the analysis with constructive discussions; Dong HJ contributed to critical review and revision of the manuscript; all the authors have read and approved the final manuscript.
Supported bythe National Key Research and Development Program of China, No. 2016YFC1301202.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hao-Jian Dong, MD, PhD, Chief Physician, Department of Internal Medicine, Guangdong Provincial People’s Hospital Zhuhai Hospital (Zhuhai Golden Bay Center Hospital), No. 2 Hongyang Road, Jinwan District, Zhuhai 519000, Guangdong Province, China. donghaojian@sina.com
Received: April 24, 2021 Peer-review started: April 24, 2021 First decision: May 24, 2021 Revised: June 3, 2021 Accepted: June 16, 2021 Article in press: June 16, 2021 Published online: August 16, 2021
Abstract
BACKGROUND
Scrub typhus is an acute infectious disease caused by rickettsia infection. The diagnosis is based on eschar, and clinical manifestations can range from asymptomatic to multiorgan dysfunction.
CASE SUMMARY
We report the case of a 35-year-old man living in Zhuhai, Guangdong, China, who had repeated high fever with a maximum body temperature of 40.2 °C and elevated white blood cells and procalcitonin levels. After 7 d of persistent high fever, the patient developed rash, abdominal pain, and symptoms of peritonitis. Within 24 h after admission, the patient developed diffuse peritonitis and pneumonedema, requiring ventilator support in the intensive care unit. However, there was no eschar on the body, and the first Weil-Felix test was negative. Taking into account that the patient had a history of jungle activities, doxycycline combined with meropenem was selected. The patient improved, healed, and was discharged after a week. The diagnosis of scrub typhus was confirmed by a repeat Weil-Felix test (Oxk 1:640), and pathology of the appendix resected by laparotomy suggests vasculitis.
CONCLUSION
This rare presentation of peritonitis, pulmonary edema, and pancreatitis caused by scrub typhus reminds physicians to be alert to the possibility of scrub typhus.
Core Tip: We report a case of scrub typhus mainly manifesting as diffuse peritonitis, pulmonary edema, and other multiorgan dysfunction, but lacking typical eschar, and the first Weil-Felix test was negative. Tracing back his travel history of jungle activities 5 d before the onset, doxycycline (100 mg q12h) was added empirically to cover atypical bacteria. He was finally discharged in a relatively stable condition under appropriate antibiotics including meropenem and doxycycline 7 d after admission. This rare presentation of peritonitis, pulmonary edema, and pancreatitis caused by scrub typhus reminds physicians to be alert to the possibility of scrub typhus.
