Scrub Typhus Presenting with Meningoencephalitis, Generalized Seizures and Bilateral Conjunctival Chemosis: A Case Report

Abstract

Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi and is an important cause of undifferentiated fever in endemic regions. Neurological involvement may manifest as meningitis, meningoencephalitis, altered sensorium and seizures. Ocular manifestations are also recognized and may include conjunctival hyperemia, subconjunctival hemorrhage, eyelid edema, uveitis and posterior segment involvement. We report a 66-year-old male farmer who developed fever and myalgia following recent jungle exposure. Scrub typhus IgM performed early in the illness was negative. His illness progressively worsened, and by the second week he developed headache, drowsiness and two generalized tonic-clonic seizures. He was febrile, semiconscious and disoriented with a Glasgow Coma Scale (GCS) score of E2V3M5. Examination revealed bilateral conjunctival chemosis, icterus, diffuse rash, neck stiffness and a black eschar over the left deltoid. Investigations revealed severe thrombocytopenia, hepatic dysfunction and renal impairment. Cerebrospinal fluid analysis showedCSF pleocytosis and CSF protein elevation. NCCT brain was normal. Repeat scrub typhus IgM during the second week was positive. The patient received intravenous doxycycline, meropenem, dexamethasone and supportive treatment. Neurological improvement began by the third day of treatment, and GCS normalized by day 7 of admission. Conjunctival chemosis and rash also improved. He was subsequently discharged and showed continued improvement at follow-up. This case highlights the importance of considering scrub typhus in acute febrile meningoencephalitis, particularly when an eschar and systemic manifestations are present. Early negative serology should not exclude the diagnosis when clinical suspicion remains high. Keywords: Scrub typhus; Meningoencephalitis; Seizure; Eschar; Conjunctival chemosis