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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
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated