ISSN - 0973-0958
Polyarthritis: An Unusual Presentation of Scrub Typhus 06/06/2018 00:00:00 https://www.pediatriconcall.com/Journal/images/journal_cover.jpg
 
DOI : 10.7199/ped.oncall.2018.26
   
 
Polyarthritis: An Unusual Presentation of Scrub Typhus
Piyush Gautam, Nivedita Sharma
Department of Pediatrics, Dr Rajendra Prasad Medical College and Hospital, Tanda, Kangra, Himachal Pradesh, India
Address for Correspondence
Dr Nivedita Sharma, Department of Pediatrics, Dr Rajendra Prasad Medical College and Hospital, Tanda at Kangra, Himachal Pradesh, India.
 
Email
niveditasharma2@yahoo.com
 
Scrub typhus is an acute febrile illness caused by infection with Orientia tsutsugamushi. (1) The clinical picture of scrub typhus consists of mainly fever, rash, myalgia and lymphadenopathy with or without organ involvement. (2) The pathognomonic features such as eschar and lymphadenopathy are seen in 50% of patients. The course of this disease may be complicated by acute respiratory distress syndrome (ARDS), acute hepatitis, acute renal failure, meningoencephalitis, disseminated intravascular coagulation, shock and myocarditis. (3) There is one report of polyarthritis and massive small bowel bleed in a patient with scrub typhus. (4) We present a child with scrub typhus who presented with only fever and polyarthritis.
A 10 years old girl presented with pain and swelling in the joints of lower limbs for 3 days and fever for one day. Pain and swelling started from left ankle joint which was sudden in onset and subsequently involved right and left knee joints by next morning. Fever was intermittent reaching upto 1020F. There was no sore throat, rash or burning micturition. On examination, vital parameters were stable and musculoskeletal examination revealed swelling, redness in left ankle and both the knee joints. Other systems were normal. The temperature over the joints was increased and movements were restricted. Clinically considering a diagnosis of acute rheumatic fever, the child was started on aspirin. However she developed right hip and elbow joint involvement on second day of hospitalization. Investigations revealed hemoglobin 12.4gm/dl, white cell count 21300 cells/cumm and erythrocyte sedimentation rate (ESR) 50 mm at end of 1 hour. CRP was positive (48 mg/dl), Antistreptolysin O (ASO) titre was < 200 IU/ml. Rheumatoid factor was negative. Ultrasonography of the joints showed thickening of the capsules with minimal effusion. Echocardiography was normal. Since our area is a scrub typhus endemic zone, scrub typhus IgM ELISA (Lubois International Inc) was sent which was positive. She was started on doxycycline which was given for 5 days. Fever defervescence occurred and arthritis improved. On follow-up the child remained asymptomatic.
 
Funding
None
Conflict of Interest
None
References :
  1. Watt G, Parola P. Scrub typhus and tropical rickettsioses. Curr Opin Infect Dis. 2003;16:429-36.
  2. Mahajan SK, Rolain JM, Kashyap R, Bakshi D, Sharma V, Prasher BS, et al. Scrub typhus in Himalayas. Emerg Infect Dis. 2006;12:1590-2.
  3. Gupta S, Dawra R, Rijhawan P, Sinha P. Recent outbreak of scrub typhus in North Western part of India. Indian J Med Microbiol. 2014;32:247.
  4. Iqbal N, Titus S, Basheer A, George S, Mookkappan S, Nair S, et al. Polyarthritis and massive small bowel bleed: An unusual combination in scrub typhus. Australas Med J. 2015;8:89–95.
Last Updated : 01 June 2018 Vol 15 Issue 2 Art #26
DOI: 10.7199/ped.oncall.2018.26
How to Cite URL :
Sharma N, Prasad R. Polyarthritis: An Unusual Presentation of Scrub Typhus. Pediatric Oncall Journal [serial online] 2018[cited 2018 April-June 1];15. Art #26. Available From : http://www.pediatriconcall.com/pediatric-journal/View/fulltext-articles/1163/J/0/0/616/0
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