title: Polyarthritis and massive small bowel bleed: An unusual combination in scrub typhus.
abstract: Scrub typhus is an acute febrile illness caused by the intracellular parasite Orientia tsutsugamushi. Although most cases present with mild symptoms and signs and recover spontaneously, some cases can be severe with multi-organ dysfunction and a protracted course, which may be fatal if left untreated. Apart from fever and constitutional symptoms, atypical presentations allow this disease to mimic several common conditions. We report a case of scrub typhus in an 18-year-old male who presented with severe polyarthritis involving all large joints and a massive lower gastrointestinal bleed from ulcers in the terminal ileum, secondary to vasculitis in the small bowel. This combination of pathologies has not previously been reported in cases of scrub typhus. The patient improved following surgical intervention and specific anti-rickettsial therapy with azithromycin.
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Nayyar
authors: N
authors: Iqbal
authors: Department of General Surgery, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Solomon
authors: S
authors: Titus
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Aneesh
authors: A
authors: Basheer
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Sanjoy
authors: S
authors: George
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Sanjoy
authors: S
authors: George
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Sudhagar
authors: S
authors: Mookkappan
authors: Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Shashikala
authors: S
authors: Nair
authors: Department of Gastroenterology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Thomas
authors: T
authors: Alexander
authors: Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Anita
authors: A
authors: Ramdas
authors: Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Sivakumar
authors: S
authors: Periyasamy
authors: Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Patricia
authors: P
authors: Anitha
authors: Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India.
authors: Reba
authors: R
authors: Kanungo
keywords: Scrub typhus; polyarthritis; small bowel bleed