Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature

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Uttam Biswas Ritwik Ghosh Arghya Chakraborty Shakilur Rahaman Mondal Dipayan Roy Arnab Bhattacharjee Debanjan Roy Julián Benito-León

Abstract

Neurological manifestations of scrub typhus, a re-emerging infectious disease of tropic/subtropics caused by Orientia tsutsugamushi infection, have been ever-evolving. Several central nervous system infections have been acknowledged for the development of cerebral venous sinus thrombosis (CVT). Nevertheless, CVT has been a rarely described addendum to the ever-evolving “neuro-scrub” spectrum. Proposed pathogenesis for the development of CVT is disseminated endotheliitis resulting in the triad of venous stasis (due to raised intracranial pressure), cerebral vasculopathy (endothelial damage), and capillary perivasculitis (endothelial damage and resultant hypercoagulable state generated by inflammatory mediators). We herein report a case of a previously healthy young female from the Indian subcontinent who was diagnosed with CVT, following scrub typhus. She responded well to conventional therapy with antibiotics and anticoagulants. CVT is amid the few completely reversible neurological catastrophes if diagnosed and treated early. Again, scrub typhus infection is treated with commonly available and extremely "affordable" antibiotics therapy. Hence, the authors propose that all cases of acute febrile illness with neurological manifestations from scrub-typhus endemic zones (like several parts of India) should be tested for the presence of Orientia tsutsugamushi infection and treated accordingly.

Keywords: cerebral venous thrombosis, neuro-scrub, Orientia tsutsugamushi, scrub typhus

Article Details

How to Cite
BISWAS, Uttam et al. Cerebral Venous Sinus Thrombosis Following Scrub Typhus Infection: A Case Report and a Review of the Literature. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3196>. Date accessed: 28 mar. 2024. doi: https://doi.org/10.18103/mra.v10i10.3196.
Section
Case Reports

References

1. Misra UK, Kalita J, Mani VE. Neurological manifestations of scrub typhus. J Neurol Neurosurg Psychiatry. 2015;86(7):761-766. doi:10.1136/jnnp-2014-308722
2. Ghosh R, León-Ruiz M, Bandyopadhyay S, Roy D, Benito-León J. Scrub typhus presenting as diaphragmatic myoclonus. Neurol Sci. 2022;43(6):4023-4024. doi:10.1007/s10072-022-06021-y
3. Ghosh R, Biswas S, Mandal A, et al. Scrub Typhus Presenting as Unilateral Abducens Nerve Palsy. Neuroophthalmology. 2021;46(2):99-103. Published 2021 Jun 4. doi:10.1080/01658107.2021.1909073
4. Biswas S, Ghosh R, Roy D, et al. Scrub Typhus Masquerading as Limbic Encephalitis. Neurohospitalist. 2022;12(1):105-110. doi:10.1177/19418744211016107
5. Ghosh R, Dubey S, Roy D, Benito-León J. Pure alexia as a presenting manifestation of scrub typhus. Neurología (2022 Jun 6). doi.org/10.1016/j.nrl.2022.04.007
6. Das S, Chattopadhyay S, Munsi K, Basu S. Scrub typhus with cerebral venous sinus thrombosis: a rare presentation. BMJ Case Rep. 2021;14(4):e241401. Published 2021 Apr 28. doi:10.1136/bcr-2020-241401
7. Chrispal A, Boorugu H, Gopinath KG, et al. Scrub typhus: an unrecognized threat in South India - clinical profile and predictors of mortality. Trop Doct. 2010;40(3):129-133. doi:10.1258/td.2010.090452
8. Jena SS, Mathew A, Sanjith A, Ajith S, Nair BR, Prakash J. Cerebral venous sinus thrombosis presentation in severe scrub typhus infection: a rare entity. Neurol India. 2014;62(3):308-310. doi:10.4103/0028-3886.136991
9. Sardana V, Shringi P. Cerebral venous sinus thrombosis in scrub typhus infection: A rare presentation. Indian Journal of Case Reports. 2019; 5(1), 22–23. doi: 10.32677/IJCR.2019.v05.i01.008
10. Ghosh R, Roy D, Mandal A, et al. Cerebral venous thrombosis in COVID-19. Diabetes Metab Syndr. 2021;15(3):1039-1045. doi:10.1016/j.dsx.2021.04.026
11. Roy D, Ghosh R, Dubey S, Dubey MJ, Benito-León J, Kanti Ray B. Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic. Can J Neurol Sci. 2021;48(1):9-24. doi:10.1017/cjn.2020.173
12. Dutta A, Ghosh R, Bhattacharya D, et al. Anti-PF4 antibody negative cerebral venous sinus thrombosis without thrombocytopenia following immunization with COVID-19 vaccine in an elderly non-comorbid Indian male, managed with conventional heparin-warfarin based anticoagulation. Diabetes Metab Syndr. 2021;15(4):102184. doi:10.1016/j.dsx.2021.06.021
13. Ghosh R, León-Ruiz M, Roy D, Naga D, Sardar SS, Benito-León J. Cerebral venous sinus thrombosis following Russell's viper (Daboia russelii) envenomation: A case report and review of the literature [published online ahead of print, 2022 Aug 27]. Toxicon. 2022;218:8-12. doi:10.1016/j.toxicon.2022.08.014
14. Ghosh R, Mandal A, León-Ruiz M, et al. Rare neurological and neuropsychiatric manifestations of scrub typhus: a case series of 10 cases [published online ahead of print, 2022 Jul 28]. Neurologia (Engl Ed). 2022;S2173-5808(22)00081-5. doi:10.1016/j.nrleng.2022.07.001
15. Tomo S, Kumar KP, Roy D, et al. Complement activation and coagulopathy - an ominous duo in COVID19. Expert Rev Hematol. 2021;14(2):155-173.

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