Abstract
Scrub typhus is tick-borne rickettsial infection and is known to become severe in rare cases. The case of a 64-year-old woman is presented. The patient presented with headache and fever higher than 39 degrees Celsius after mushroom hunting 9 days prior to admission. Then, she developed impaired consciousness and respiratory failure and was transferred from another hospital to our hospital. She developed multiorgan failure associated with septic shock, disseminated intravascular coagulation and acute respiratory distress syndrome and was admitted to the ICU. Hemorrhagic shock requiring emergency endoscopic hemostasis occurred twice from a hemorrhagic gastric ulcer during her illness. Scrub typhus was suspected because of the medical history and characteristic skin rash, therefore, treatment with minocycline was administered, which resulted in improvement of the systemic symptoms. After day 10, the cognitive decline and character change were still present with new appearance of hyperalbuminorrhachia. Consequently, the patient was diagnosed as having encephalitis caused by scrub typhus. The encephalitis was improved and the patient was discharged on day 27. The principal symptom of scrub typhus is considered to be vasculitis due to vascular endothelial cell disorder. The vasculitis may be associated with not only multiorgan failure, but also multiple gastric mucosal injury and encephalitis in this case.
