Meningeal Signs and Cerebellar Involvement in Scrub Typhus: A Case Report

Scrub typhus is an arthropod-borne fever that follows the bite of the larval form of Leptotrombidium mite carrying Orientia tsutsugamushi. It remains a serious health problem in the Asia-Pacific region. While it commonly presents as an undifferentiated fever with chills and an eschar, complications like pneumonitis, acute respiratory distress syndrome, disseminated intravascular coagulation, and meningoencephalitis may cause scrub typhus to be fatal. However, regardless of the dramatic presentation, treatment with antibiotics, preferably doxycycline or even azithromycin, is effective in recovery. In this case report, we present a case of meningitis and cerebellar involvement in an adolescent with positive scrub typhus serology in the absence of an eschar. This brought forward a diagnostic delay as other infections including tuberculosis were considered before scrub typhus due to unusual presenting symptoms and the lack of an eschar. Thus, in cases like these, it becomes imperative to be aware of the unusual manifestations to initiate antibiotics on time and prevent further complications.