title: Scrub typhus-associated acute disseminated encephalomyelitis.
abstract: BACKGROUND
  Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disease of the central nervous system, typically occurring after infections or vaccinations. To our knowledge, scrub typhus has not been described in association with ADEM.
  
  
  METHODS
  A 77-year-old man was admitted with fever, convulsions and an altered level of consciousness. On neurological examination, the patient was stuporous and had nuchal rigidity and left hemiparesis. A generalized tonic-clonic seizure was observed. Serum and cerebrospinal fluid samples were positive for anti-Orientia tsutsugamushi antibody. Despite a 10-day course of parenteral minocycline, his clinical condition deteriorated. Serial cranial magnetic resonance images demonstrated progressively extensive areas of signal hyperintensity on conventional T2-weighted and fluid attenuated inversion recovery sequence images, mainly affecting the periventricular white matter. After administration of intravenous high-dose corticosteroids, the patient had limited improvement.
  
  
  CONCLUSIONS
  This is the first identifiable case of ADEM temporally associated with scrub typhus alone.
authors.affiliation: Department of Neurology, Mackay Memorial Hospital, Taitung, Taiwan. a766288.chen@msa.hinet.net
authors.forename: Pei-Hao
authors.initials: PH
authors.lastname: Chen
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Hung
authors.forename: Shih-Jung
authors.initials: SJ
authors.lastname: Cheng
authors.forename: Kuang-Nan
authors.initials: KN
authors.lastname: Hsu
mesh_terms: D000368:Aged; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012612:Scrub Typhus / Q000150:complications*