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Chronic encephalopathy and locked-in state due to scrub typhus related CNS vasculitis
Journal of Neuroimmunology ( IF 2.9 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jneuroim.2020.577303 Sanjiv Sharma 1 , Samhita Panda 1 , Sarbesh Tiwari 2 , Apoorv Patel 1 , Vidhi Jain 3
Journal of Neuroimmunology ( IF 2.9 ) Pub Date : 2020-09-01 , DOI: 10.1016/j.jneuroim.2020.577303 Sanjiv Sharma 1 , Samhita Panda 1 , Sarbesh Tiwari 2 , Apoorv Patel 1 , Vidhi Jain 3
Affiliation
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BACKGROUND
Scrub Typhus, prevalent in Asia-Pacific region, often has neurological manifestations in the setting of acute febrile illness, as acute encephalitis syndrome. CASE REPORT
A 20-year-old female, from western Rajasthan, India presented with calf pain followed by nausea, vomiting, dizziness, and sequentially progressive weakness of limbs, anarthria and loss of bladder control over 10 days. MRI Brain showed T2-weighted and FLAIR hyperintense lesions in corpus callosum, subcortical and periventricular white matter, basal ganglia, thalamus, brainstem and cerebellum producing starry sky appearance with diffusion restriction. Serum IgM for Scrub typhus was positive and patient progressively improved over 3 weeks with doxycycline. CONCLUSIONS
This report highlights an unusual presentation of scrub typhus with subacute onset and static course, quadriparesis and locked-in state for 2 months, suspected based on red flags on neuroimaging and reversal of deficits with appropriate treatment.
中文翻译：
恙虫病相关中枢神经系统血管炎引起的慢性脑病和闭锁状态
背景 恙虫病在亚太地区流行，通常在急性发热性疾病中出现神经系统表现，如急性脑炎综合征。病例报告 一名来自印度拉贾斯坦邦西部的 20 岁女性在 10 天内出现小腿疼痛，随后出现恶心、呕吐、头晕、继发进行性四肢无力、心律失常和膀胱失控。大脑 MRI 显示胼胝体、皮质下和脑室周围白质、基底神经节、丘脑、脑干和小脑出现 T2 加权和 FLAIR 高信号病变，产生扩散受限的星空外观。恙虫病血清 IgM 呈阳性，患者在使用多西环素治疗 3 周后病情逐渐好转。结论 本报告强调了恙虫病的一种不寻常表现，具有亚急性起病、静态病程、四肢瘫痪和长达 2 个月的闭锁状态，怀疑是基于神经影像学上的危险信号和通过适当治疗逆转缺陷。
更新日期：2020-09-01
中文翻译：
恙虫病相关中枢神经系统血管炎引起的慢性脑病和闭锁状态
背景 恙虫病在亚太地区流行，通常在急性发热性疾病中出现神经系统表现，如急性脑炎综合征。病例报告 一名来自印度拉贾斯坦邦西部的 20 岁女性在 10 天内出现小腿疼痛，随后出现恶心、呕吐、头晕、继发进行性四肢无力、心律失常和膀胱失控。大脑 MRI 显示胼胝体、皮质下和脑室周围白质、基底神经节、丘脑、脑干和小脑出现 T2 加权和 FLAIR 高信号病变，产生扩散受限的星空外观。恙虫病血清 IgM 呈阳性，患者在使用多西环素治疗 3 周后病情逐渐好转。结论 本报告强调了恙虫病的一种不寻常表现，具有亚急性起病、静态病程、四肢瘫痪和长达 2 个月的闭锁状态，怀疑是基于神经影像学上的危险信号和通过适当治疗逆转缺陷。
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