title: Case of scrub typhus complicated by severe disseminated intravascular coagulation and death.
abstract: Scrub typhus is an infectious disease that is caused by Orientia tsutsugamushi. The authors describe an autopsied case of scrub typhus complicated with severe disseminated intravascular coagulation (DIC). An 82-year-old man complained of fever 4 days after climbing a mountain. The patient was admitted to an urban hospital, and meropenem and ceftriaxone were administered. The patient's condition deteriorated and he was transferred to a second hospital. On physical examination, a black scab was found and scrub typhus was suspected. Despite intensive treatment, the patient died on the fifth day. High levels of O. tsutsugamushi IgM antibody were confirmed. An autopsy revealed systemic vasculitis and perivasculitis. The endothelial tissue of the white pulp of the spleen was markedly infiltrated by plasma cells. The authors speculated that a severe immune reaction against O. tsutsugamushi enhanced an inflammatory response, leading to DIC. This case is a warning to doctors who are not familiar with scrub typhus.
authors.affiliation: Department of Emergency and Critical Care Medicine, Fukushima Medical University, Fukushima, Japan. windmill@fmu.ac.jp
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ono
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Ikegami
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Tasaki
authors.forename: Masahumi
authors.initials: M
authors.lastname: Abe
authors.forename: Choichiro
authors.initials: C
authors.lastname: Tase
mesh_terms: D058186:Acute Kidney Injury; D000369:Aged, 80 and over; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D007075:Immunoglobulin M; D008297:Male; D012285:Orientia tsutsugamushi; D012612:Scrub Typhus / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology
chemical_list: D007075:Immunoglobulin M