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A case report of scrub typhus-associated hemophagocytic syndrome and a review of literature.
[scrub typhus]
A
34
-
year
-old
woman
presented
with
septic
shock
,
disseminated
intravascular
coagulation
(
DIC
)
,
and
multiorgan
dysfunction
with
a
1
-
week
history
of
fever
,
abdominal
pain
in
the
right
upper
quadrant
,
and
dull
pain
in
the
right
flank
.
Physical
and
laboratory
data
showed
cytopenia
(
thrombocytopenia
and
anemia
)
,
splenomegaly
,
hyperferritinemia
,
hypofibrinogenemia
,
and
an
elevated
level
of
interleukin-
2
receptor
(
soluble
CD
2
5
)
.
Bone
marrow
examinations
disclosed
hypercellular
marrow
with
increased
infiltration
of
histiocytes
with
hemophagocytosis
.
This
diagnosis
was
confirmed
by
positive
Weil-
Felix
test
results
(
Proteus
mirabilis
OX-K
titer
,
1
:
80
)
,
the
presence
of
IgG
and
IgM
antibodies
,
and
positive
PCR
results
for
Orientia
tsutsugamushi
.
The
patient
developed
a
severe
intracranial
hemorrhage
3
days
after
admission
and
expired
due
to
systemic
inflammatory
response
syndrome
with
DIC
and
multiorgan
failure
on
the
13
th
day
of
hospitalization
.
Scrub
typhus
with
hemophagocytic
syndrome
can
be
complicated
by
DIC
and
multiorgan
failure
.
Patients
with
scrub
typhus
usually
have
an
excellent
response
to
treatment
;
therefore
,
early
diagnosis
and
prompt
administration
of
antimicrobial
therapy
may
prevent
the
development
of
serious
complications
.
Diseases
Validation
Diseases presenting
"disseminated intravascular coagulation"
symptom
heparin-induced thrombocytopenia
junctional epidermolysis bullosa
malignant atrophic papulosis
pyomyositis
scrub typhus
systemic capillary leak syndrome
This symptom has already been validated