Myocarditis with Unidigital Gangrene in Scrub Typhus Patient – Rare Case

Abstract

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, an obligate intracellular
bacterium. The disease is of greatest public health importance in rural areas of Asia and the Western Pacific Islands. The
clinical manifestations range from subclinical disease to organ failure. The chief target of organism is the vascular endothelium
of various organs. There is inflammation in and around the blood vessels that causes endothelial damage resulting in
vascular leakage and organ dysfunction. Case report: A 70-year-old female patient, farmer by occupation, presented to
us with features of acute febrile illness and shortness of breath and was diagnosed as scrub typhus with myocarditis. She
subsequently developed gangrene of right little finger. The patient was investigated for infectious and noninfectious causes
of vasculitis leading to gangrene. We established that the cause for gangrene was scrub typhus as evidenced by presence of
eschar and positive serology. Conclusion: We report for the first time a case of scrub typhus complicated by both myocarditis
and gangrene. Both myocarditis and unidigital gangrene are unusual complications of scrub typhus. Hence, scrub typhus
should be ruled out in patients who present with these complications.