Scrub typhus-associated acute disseminated encephalomyelitis.
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.
Chen
Pei-Hao
PH
Department of Neurology, Mackay Memorial Hospital, Taitung, Taiwan. a766288.chen@msa.hinet.net
Hung
Kuo-Hua
KH
Cheng
Shih-Jung
SJ
Hsu
Kuang-Nan
KN
D000368:Aged; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012612:Scrub Typhus / Q000150:complications*