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Table of Contents
CASE REPORT
Year : 2022  |  Volume : 11  |  Issue : 5  |  Page : 53-54

Acute pancreatitis due to scrub typhus


1 Sri Venkateswara Institute of Medical Sciences, Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
2 Department of Nephrology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Submission25-Mar-2020
Date of Decision07-Jun-2021
Date of Acceptance11-Jun-2021
Date of Web Publication30-Aug-2022

Correspondence Address:
R Ram
Department of Nephrology, Professor and Head, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_29_20

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  Abstract 


Scrub typhus caused by organism Orientia tsutsugamushi and transmitted to humans by the bite of a leptotrombidium mite (chigger). Although eschar formation is one of the important signs that aid in diagnosis, multiple eschar formation is a rare presentation. Although scrub typhus causes multiple organ dysfunction, the pancreas involvement is rare. Here, we describe a patient with scrub typhus with multiple eschars complicated with acute pancreatitis and acute kidney injury.

Keywords: Acute kidney injury, acute pancreatitis, eschars, scrub typhus


How to cite this article:
Lakshmi G S, Yeshaswini S, Alekhya B, Manuel MB, Sunnesh A, Ram R, Kumar V S. Acute pancreatitis due to scrub typhus. J Clin Sci Res 2022;11, Suppl S1:53-4

How to cite this URL:
Lakshmi G S, Yeshaswini S, Alekhya B, Manuel MB, Sunnesh A, Ram R, Kumar V S. Acute pancreatitis due to scrub typhus. J Clin Sci Res [serial online] 2022 [cited 2022 Dec 7];11, Suppl S1:53-4. Available from: https://www.jcsr.co.in/text.asp?2022/11/5/53/355072




  Introduction Top


Scrub typhus caused by Orientia tsutsugamushi and transmitted to humans by the bite of a leptotrombidium mite (chigger). Most patients of scrub typhus occur in rural areas of Southeast Asia, Indonesia, China, Japan, India and northern Australia. Eschar aids in early diagnosis of scrub typhus. Scrub typhus causes multi-organ dysfunction, yet involvement of pancreas is uncommon. Here, we report a patient with scrub typhus with multiple eschars complicated with acute pancreatitis and acute kidney injury.


  Case Report Top


A 50-year-old female presented with abrupt onset of high-grade fever associated with chills and rigors of 3-day duration. She also had 4–5 episodes of vomiting per day. The vomiting was non-bilious, non-blood stained, non-projectile and contained food particles of the past 3 days. She had a history of epigastric pain for 3 days. She also had breathlessness, facial puffiness and lower limb swelling for 3 days. She also had a history of decreased urine output which for 3 days. On examination, eschars were found on the right and left axilla and on right side of the neck. Anaemia, subconjunctival haemorrhage and paedal odema were also present. There were no jaundice and lymphadenopathy. She had bilateral crackles and hepatomegaly. Blood pressure was 90/60 mmHg. Laboratory testing showed serum creatinine 8.02 mg/dL, blood urea 186 mg/dL, serum sodium 131 mEq/L, serum potassium 5.0 mEq/L, serum amylase 74 IU/L, serum calcium 7.7 mg/dL, haemoglobin 10.6 g/dL, total leucocyte count 10,500 cells/mm3 and platelet count 193,000/mm3. Scrub typhus was diagnosed by the positive qualitative immunoglobulin M enzyme-linked immunosorbent assay (In Bios International Inc., Seattle, USA). The tests done for malaria, dengue, leptospira were negative. Computed tomography (CT) revealed bulky head of pancreas, free fluid around porta hepatis and pancreas, peripancreatic and mesenteric fat stranding, suggestive of acute pancreatitis. CT also showed the size of kidneys: right: 12.7 cm × 4.9 cm, left: 12.9 cm × 4.1 cm; both kidneys were bulky, bilateral perinephric fat stranding noted [Figure 1], calculus measuring 6 mm noted in mid pole and 4 mm in lower pole of left kidney.
Figure 1: Computed tomography abdomen (plain) axial section showing peripancreatic and mesenteric fat stranding and free fluid around porta hepatis and pancreas

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The treatment administered included nil peroral, parenteral doxycycline, proton pump inhibitors and haemodialysis for 6 sessions. The patient remained in the intensive care unit till the end of the dialysis sessions and improvement in urine output. Later, in the ensuing 6 weeks, the urine output improved to >3.0 L per day and serum creatinine values declined to 1.30 mg/dL. After 4 weeks of discharge, patient presented to nephrology. The serum creatinine and serum amylase have returned to normal.


  Discussion Top


Scrub typhus is a febrile illness associated with multi-organ dysfunction. The clinical features were gastrointestinal presentations such as duodenal ulcer perforation, peritonitis, acute acalculous cholecystitis; respiratory manifestations such as acute respiratory distress syndrome; neurological manifestations such as meningoencephalitis and acute renal failure, disseminated intravascular coagulation and myocarditis. However, acute pancreatitis is a rare presentation. The cause of acute pancreatitis in scrub typhus is not known. The proposed mechanism is endothelial invasion of microorganisms causing vasculitis and perivasculitis.[1] Our patient presented with fever, eschars, positive serology for rickettsial infection and CT suggested acute pancreatitis. There were a few reports of acute pancreatitis with scrub typhus. The reports included both as an isolated infection[1],[2],[3] and as a part of mixed infection.[4],[5] Infectious causes of acute pancreatitis include mumps, coxsackievirus, cytomegalovirus, mycoplasma, legionella, Salmonella and Aspergillus. Mortality in scrub typhus varies from 12% to 50%.[2] The reported mortality rate due to scrub typhus complicated with acute renal failure was 29.7%,[2] and when associated with acute pancreatitis, it was 42.8%.[1]

The final diagnosis of scrub typhus leading to acute pancreatitis had been based on clinical, biochemical and radiology features of acute pancreatitis in the patient of scrub typhus and without any other causative factor for acute pancreatitis.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors are faculty members/Postgraduate students/ residents of Sri Venkateswara Institute of Medical Sciences, Tirupati, of which Journal of Clinical and Scientific Research is the official Publication. The article was subject to the journal's standard procedures, with peer review handled independently of these faculty and their research groups.



 
  References Top

1.
Ahmed AS, Kundavaram AP, Sathyendra S, Abraham OC. Acute pancreatitis due to scrub typhus. J Glob Infect Dis 2014;6:31-4.  Back to cited text no. 1
    
2.
Bhatt A, Menon AA, Bhat R, Gurusiddana SG. Pancreatitis in scrub typhus. J Glob Infect Dis 2014;6:28-30.  Back to cited text no. 2
    
3.
Yi SY, Tae JH. Pancreatic abscess following scrub typhus associated with multiorgan failure. World J Gastroenterol 2007;13:3523-5.  Back to cited text no. 3
    
4.
Wu KM, Wu ZW, Peng GQ, Wu JL, Lee SY. Radiologic pulmonary findings, clinical manifestations and serious complications in scrub typhus: Experiences from a teaching hospital in Eastern Taiwan. Int J Gerontol 2009;3:223-32.  Back to cited text no. 4
    
5.
Iqbal N, Viswanathan S, Remalayam B, Muthu V, George T. Pancreatitis and MODS due to scrub typhus and dengue co-infection. Trop Med Health 2012;40:19-21.  Back to cited text no. 5
    


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