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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
"early diagnosis"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
alexander disease
allergic bronchopulmonary aspergillosis
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
classical phenylketonuria
coats disease
cohen syndrome
congenital adrenal hyperplasia
congenital diaphragmatic hernia
congenital toxoplasmosis
cowden syndrome
cushing syndrome
cutaneous mastocytosis
cystinuria
dentin dysplasia
dentinogenesis imperfecta
dracunculiasis
erdheim-chester disease
erythropoietic protoporphyria
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial hypocalciuric hypercalcemia
familial mediterranean fever
gm1 gangliosidosis
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
inclusion body myositis
kabuki syndrome
kallmann syndrome
kindler syndrome
krabbe disease
locked-in syndrome
monosomy 21
neuralgic amyotrophy
oculocutaneous albinism
oligodontia
omenn syndrome
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
primary effusion lymphoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
triple a syndrome
typhoid
von hippel-lindau disease
wiskott-aldrich syndrome
wolf-hirschhorn syndrome
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