Scrub Typhus Presenting as Bilateral Sixth Nerve Palsy

Scrub typhus, a tropical rickettsial infection, can have various neurological manifestations. Here, we present the case of an otherwise healthy 19-year-old female who presented to the emergency department with fever, headache, and diplopia. On examination, she was found to have bilateral sixth nerve...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2024-03, Vol.16 (3), p.e56692
Main Authors: Bhattacharjee, Sukriti, Debbarma, Bibhu, Debbarma, Rajesh K, Das, Gourab
Format: Article
Language:English
Subjects:
Cerebrospinal fluid
Diplopia
Encephalitis
Fever
Headaches
Hearing loss
Illnesses
Infectious Disease
Internal Medicine
Meningitis
Nervous system
Neurological disorders
Neurology
Typhus
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Summary:Scrub typhus, a tropical rickettsial infection, can have various neurological manifestations. Here, we present the case of an otherwise healthy 19-year-old female who presented to the emergency department with fever, headache, and diplopia. On examination, she was found to have bilateral sixth nerve palsy and bilateral papilledema. Initial unenhanced CT of the brain and CT venogram were unremarkable. The cerebrospinal fluid study was normal. Later, bloodwork revealed high titers of antibody. A thorough physical examination revealed no evidence of any eschar. She was treated with doxycycline and had significant clinical improvement with partial recovery of bilateral lateral rectus function. We want to highlight the importance of maintaining a high index of suspicion for atypical neurological presentations of scrub typhus.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.56692