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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 42

Acute respiratory distress syndrome in scrub typhus


Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012, India

Date of Submission01-Oct-2019
Date of Web Publication25-May-2021

Correspondence Address:
Ashok Kumar Pannu
Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1690_19

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How to cite this article:
Saroch A, Pannu AK. Acute respiratory distress syndrome in scrub typhus. Indian J Med Res 2020;152, Suppl S1:42

How to cite this URL:
Saroch A, Pannu AK. Acute respiratory distress syndrome in scrub typhus. Indian J Med Res [serial online] 2020 [cited 2021 Aug 4];152, Suppl S1:42. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/42/316725

The child's assent and parents' consent obtained to publish clinical information and images.


A 17 yr old male child admitted with fever and rapidly progressive dyspnoea for 10 days in the Emergency department of Postgraduate Institute of Medical Education & Research, Chandigarh, India, in September 2019. At admission, his oxygen saturation was 84 per cent on room air. Physical examination revealed a black crusted eschar surrounded by an erythematous halo in the right axilla [Figure 1]. Bilateral diffuse lung crackles and mild splenomegaly were present on systemic examination. The chest radiograph showed bilateral lung infiltrates [Figure 2]A. Arterial blood gas analysis revealed a PaO2:FiO2 ratio of 190. A nested PCR of the gene encoding the 56-kDa antigen of the Gilliam strain of Orientia tsutsugamushi in the blood was positive. A diagnosis of scrub typhus with acute respiratory distress syndrome (ARDS) was made. The patient improved with antibiotics and mechanical ventilation for 72 h. A follow up radiograph at three weeks was normal [Figure 2]B.
Figure 1: Black crusted eschar surrounded by an erythematous halo in the right axilla, a pathognomonic finding in the scrub typhus (arrows head).

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Figure 2: (A) Chest radiograph showing bilateral lung infiltrates consistent with acute respiratory distress syndrome. (B) A normal radiograph at a three-week follow up.

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A careful search for eschar is warranted in patients with acute undifferentiated febrile illness, as it makes a definite bedside diagnosis of scrub typhus.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2]



 

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