Scrub typhus presenting as Purpura fulminans

JOURNAL TITLE: Indian Journal of Critical Care Medicine

Author
1. Srikanth Jawalkar
2. Suhasini Tirumala
3. Pavithra Vani Patalay
4. Pradeep Kumar Mishra
5. Pavani Nimmala
6. Sudha Ayyagari
ISSN
0972-5229
DOI
10.4103/0972-5229.136081
Volume
18
Issue
7
Publishing Year
2014
Pages
3
Author Affiliations
    1. Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
    1. Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
    1. Department of General Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
    1. Department of Dermatology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
    1. Department of Pathology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India
    1. Yashoda Hospital, Secunderabad, Andhra Pradesh, India
  • Article keywords
    Indian tick typhus, purpura, Rickettsia, Weil-Felix test, doxycycline

    Abstract

    Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.

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