title: Acute pancreatitis due to scrub typhus.
abstract: Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death. Acute pancreatitis as a complication is very rare and is potentially fatal. This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis. The mean age of the seven patients with acute pancreatitis was 49.4 years, and mean duration of fever prior to presentation was 7.7 days. All seven patients had abdominal pain, and three had a pathognomonic eschar. The mean serum lipase level was 1,509 U/L (normal value: <190 U/L) and the mean serum amylase level was 434 U/L (normal value: <200 U/L). Six patients had evidence of multi-organ dysfunction. Hematological and respiratory system dysfunction was seen in five patients, hepatic and renal dysfunction in four, and central nervous system dysfunction in three patients. Three patients who had ≥4 organs involved, died (mortality rate: 42.8%). Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present, is associated with increased mortality (42.8%). Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed.
authors.affiliation: Department of General Medicine, Medicine Unit IV, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Atif Shaikh Iqbal
authors.initials: AS
authors.lastname: Ahmed
authors.affiliation: Department of General Medicine, Medicine Unit IV, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Abhilash Paul Prabhakar
authors.initials: AP
authors.lastname: Kundavaram
authors.affiliation: Department of Medicine Unit III, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Sathyendra
authors.affiliation: Department of Medicine Unit I and Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Ooriapadickal C
authors.initials: OC
authors.lastname: Abraham
keywords: Complication; Pancreatitis; Scrub typhus
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