Scrub Typhus with Multiple Cranial Nerve Palsy: A Rare Case Presentation

Abstract

Scrub typhus, a rickettsial disease endemic in several parts of India, usually presents with acute symptoms. It is caused
by small intracellular Gram-negative bacteria belonging to the Rickettsiaceae family. Optic neuritis and lateral rectus palsy
may be associated with a range of autoimmune disorders, infectious diseases and raised intracranial tension. In this case,
we report optic neuritis and lateral rectus palsy induced by Orientia tsutsugamushi. We report a case of a 23-year-old woman
presenting with complaints of high-grade fever, vomiting and generalized swelling since 5 days. During this febrile period,
on 4/10/2021, she complained of difficulty in vision and double vision. She was found to be positive for scrub typhus on
5/10/2021. Optic neuritis was diagnosed on the basis of ophthalmologic examination and magnetic resonance imaging (MRI)
brain. Investigation was done to rule out autoimmune disorders (vasculitis and connective tissue diseases). Rickettsial optic
neuritis was confirmed by detection of specific antibodies in serum and the negativity of other serologic tests. Fever, eschar,
history of tick exposure and supportive diagnostic tests usually lead to the diagnosis. This case aims to raise awareness
among the healthcare providers for this type of association. Scrub typhus should be included in the differential diagnosis
when a patient presents with fever with or without eschar and isolated or multiple cranial nerve palsy.