Tuberc Respir Dis.  2006 Oct;61(4):389-393.

A case of ARDS Overlooked Tsutstugamushi Disease that Presented as Simple Cutaneous Lesions

• Ryu KH
• Kim KH
• Kim HD
• Son JW
• Na MJ
• Choi E

Abstract

Tsutstugamushi disease is a major febrile disease that generally occurs in the fall in Korea with hemorrhagic fever with renal syndrome and leptospirosis. This disease is often accompanied by interstitial pneumonia, acute renal failure and liver failure. The causative agent, namely Orientia tsutsugamushi, is transmitted to humans through the bite of a laval trombiculid mite, which is commonly known as a chigger. A 78 year old man was admitted in October 2004 with intractable fever and a drowsy mentality. Two weeks earlier, he visited a private clinic complaining of a simple skin rash. He was treated with antihistamine and steroid, but his symptoms were aggravated and he was referred to our hospital. His physical examination and laboratory findings showed a septic shock status. The maculopapular rash had spread over his face, chest, abdomen and extremities. Eschar was observed in lower back area but it was too difficult to distinguish it from other skin rashes. His chest X-ray appeared as diffuse nodular patchy consolidations in the bilateral lung parenchyme. He was treated with a mechanical ventilator and doxycycline under th suspicion of Tsutstugamushi disease. However, he suffered multiorgan failure accompanied by acute respiratory distress syndrome, acute renal failure and acute hepatitis. He was treated in the intensive care unit for approximately 12 weeks and his general condition was recovered.

Keyword

Scrub typhus; Acute respiratory distress syndrome; Rash

MeSH Terms

Abdomen
Acute Kidney Injury
Aged
Doxycycline
Exanthema
Extremities
Fever
Hemorrhagic Fever with Renal Syndrome
Hepatitis
Humans
Intensive Care Units
Korea
Leptospirosis
Liver Failure
Lung
Lung Diseases, Interstitial
Orientia tsutsugamushi
Physical Examination
Respiratory Distress Syndrome, Adult
Scrub Typhus
Shock, Septic
Thorax
Trombiculidae
Ventilators, Mechanical
Doxycycline

Figure

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  Figure 1 Maculopapular rash was spreaded on skin of face(A), chest, abdomen(B) and leg(C). (D) Eschar was seen in lower back area.

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  Figure 2 Diffuse lung consolidation in both lung field.

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