title: Scrub typhus hepatitis confirmed by immunohistochemical staining.
abstract: Scrub typhus is an acute febrile disease caused by Orientia tsutsugamushi (O. tsutsugamushi). We report herein the case of a woman who presented with fever and elevated serum levels of liver enzymes and who was definitively diagnosed with scrub typhus by histopathological examination of liver biopsy specimens, serological tests and nested polymerase chain reaction. Immunohistochemical staining using a monoclonal anti-O. tsutsugamushi antibody showed focally scattered positive immunoreactions in the cytoplasm of some hepatocytes. This case suggests that scrub typhus hepatitis causes mild focal inflammation due to direct liver damage without causing piecemeal necrosis or interface hepatitis. Thus, scrub typhus hepatitis differs from acute viral hepatitis secondary to liver damage due to host immune responses, which causes severe lobular disarray with diffuse hepatocytic degeneration, necrosis and apoptosis as well as findings indicative of hepatic cholestasis, such as hepatic bile plugs or brown pigmentation of hepatocytes.
authors.affiliation: Department of Internal Medicine, Chosun University College of Medicine, Gwangju 501-717, South Korea.
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Chung
authors.forename: Sung-Chul
authors.initials: SC
authors.lastname: Lim
authors.forename: Na-Ra
authors.initials: NR
authors.lastname: Yun
authors.forename: Sung-Heui
authors.initials: SH
authors.lastname: Shin
authors.forename: Choon-Mee
authors.initials: CM
authors.lastname: Kim
authors.forename: Dong-Min
authors.initials: DM
authors.lastname: Kim
mesh_terms: D001706:Biopsy; D005260:Female; D006505:Hepatitis / Q000175:diagnosis*; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000473:pathology; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012612:Scrub Typhus / Q000175:diagnosis*; D012698:Serologic Tests