Korean J Med.  2017 Jun;92(3):321-325. 10.3904/kjm.2017.92.3.321.

Severe Scrub Typhus with Hemophagocytic Lymphohistiocytosis Occurring in Summer

• Ahn JS
• Noh JH
• Kim HR
• Jung J
• Jo JC
• Lim JH
• Jun JB

• KMID: 2410197
• DOI: http://doi.org/10.3904/kjm.2017.92.3.321

Abstract

In Korea, scrub typhus usually occurs in October and November. Hemophagocytic lymphohistiocytosis (HLH) is a distinct clinical entity characterized by a high fever, pancytopenia, hepatosplenomegaly, histiocyte proliferation, and hemophagocytosis. We encountered a summertime case of severe scrub typhus presenting as HLH. A 49-year-old female complained of abdominal pain and fever 3 days in duration. On hospital day 3 she was transferred to the intensive care unit because of clinical deterioration accompanied by severe sepsis. As an eschar was evident on the right shoulder, we commenced doxycycline. Her condition improved dramatically and she was discharged on day 14. Although the indirect immunofluorescence antibody test (IFA) for Orientia tsutsugamushi was negative on admission, a repeat IFA test was positive; the antibody titer was 1:5,120 on hospital day 10. Scrub typhus should be considered during differential diagnosis in a patient with severe sepsis in any season except the fall.

Keyword

Scrub typhus; Lymphohistiocytosis, Hemophagocytic; Summer

MeSH Terms

Abdominal Pain
Diagnosis, Differential
Doxycycline
Female
Fever
Fluorescent Antibody Technique, Indirect
Histiocytes
Humans
Intensive Care Units
Korea
Lymphohistiocytosis, Hemophagocytic*
Middle Aged
Orientia tsutsugamushi
Pancytopenia
Scrub Typhus*
Seasons
Sepsis
Shoulder
Doxycycline