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LETTER TO EDITOR
Year : 2014  |  Volume : 62  |  Issue : 1  |  Page : 82-83

A rare case of Guillain-Barre syndrome following scrub typhus


Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India

Date of Submission10-Dec-2013
Date of Decision29-Jan-2014
Date of Acceptance26-Jan-2014
Date of Web Publication7-Mar-2014

Correspondence Address:
Vishal M Sawale
Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.128340

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How to cite this article:
Sawale VM, Upreti S, Singh T, Singh N B, Singh T. A rare case of Guillain-Barre syndrome following scrub typhus. Neurol India 2014;62:82-3

How to cite this URL:
Sawale VM, Upreti S, Singh T, Singh N B, Singh T. A rare case of Guillain-Barre syndrome following scrub typhus. Neurol India [serial online] 2014 [cited 2019 Sep 22];62:82-3. Available from: http://www.neurologyindia.com/text.asp?2014/62/1/82/128340


Sir,

Scrub typhus is an acute febrile disease caused by Rickettsia. The neurological complications of scrub typhus include aseptic meningitis, [1] meningoencephalitis, [2] seizures, delirium, hearing loss, cerebellitis, myelitis. Very few cases of Guillain-Barre syndrome (GBS) have been reported. [3],[4],[5] We report probably the first case of GBS from India. Here, we report the first case of GBS following scrub typhus from India.

A 41-year-old male farmer by occupation presented with moderate to high grade fever of 7 days duration and brick red rashes on the anterior chest with tender and enlarged lymph nodes of 2-3 cm in both inguinal region. A painless, non-itchy ulcerated lesion of 1 cm × 2 cm with an erythematous halo in the lower part of the scrotum was present [Figure 1]. Investigation work-up including complete blood picture, biochemistry, Widal test, and test for malaria parasite was normal. Serological tests for hepatitis B, hepatits C, human immunodeficiency virus 1 and 2, cytomegalovirus, Ebstein-Barr virus, Leptospira, and herpes simplex virus was negative. Scrub typhus antibody was positive (solid phase immunochromatographic assay). Lymph node biopsy of inguinal region revealed reactive lymphadenitis. Patient improved with doxycycline and discharged on 4 th day. The patient was readmitted after 4 days of discharge with an acute onset flaccid quadriparesis, first involving lower limbs and evolving over the next 24 h to involve both upper limbs.
Figure 1: Scrotal eschar after scab has fallen

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Examination revealed left lower motor neuron type of facial paresis and hypotonia of all the four limbs with motor power of 2/5. The anterior abdominal muscles and paraspinal muscles showed marked weakness and patient could not support self in sitting position. Deep tendon reflexes were not electable and plantar responses were flexor. Cerebrospinal fluid (CSF) analysis showed albuminocytologic dissociation (protein 196, cell count-02). Electrodiagnostic studies were suggestive of demyelinating neuropathy [Table 1]. F-Waves were absent in all tested nerves. With the diagnosis of GBS, patient was treated with five cycles of plasmapheresis. Over a period of 2 weeks there was gradual improvement in motor power to 4/5 and he was discharged after 4 weeks.

In this patient serology for viral infections that predispose to GBS was negative. In this patient, there was a clear temporal relationship between scrub typhus infection and the onset of flaccid weakness. Electrodiagnostic studies and CSF studies showing albino-cytological dissociation were suggestive of acute inflammatory demyelinating polyradiculoneuropathy, a type of GBS.
Table 1: Electrodiagnostic studies

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 » References Top

1.Silpapojakul K, Ukkachoke C, Krisanapan S, Silpapojakul K. Rickettsial meningitis and encephalitis. Arch Intern Med 1991;151:1753-7.  Back to cited text no. 1
    
2.Kim DE, Lee SH, Park KI, Chang KH, Roh JK. Scrub typhus encephalomyelitis with prominent focal neurologic signs. Arch Neurol 2000;57:1770-2.  Back to cited text no. 2
    
3.Lee MS, Lee JH, Lee HS, Chang H, Kim YS, Cho KH, et al. Scrub typhus as a possible aetiology of Guillain-Barré syndrome: Two cases. Ir J Med Sci 2009;178:347-50.  Back to cited text no. 3
    
4.Ju IN, Lee JW, Cho SY, Ryu SJ, Kim YJ, Kim SI, et al. Two cases of scrub typhus presenting with Guillain-Barré syndrome with respiratory failure. Korean J Intern Med 2011;26:474-6.  Back to cited text no. 4
    
5.Lee SH, Jung SI, Park KH, Choi SM, Park MS, Kim BC, et al. Guillain-Barré syndrome associated with scrub typhus. Scand J Infect Dis 2007;39:826-8.  Back to cited text no. 5
    


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