Abstract
Hemophagocytic Lympho-histiocytosis (HLH) is a rare life-threatening
condition characterized by widespread activation of the immune system
leading to tissue damage all over the body. It is divided into Primary
HLH due to inborn error in lymphocytes, T cells, and macrophages and
Secondary HLH which is mostly due to infections, systemic connective
tissue diseases, and lymphoid malignancies. Here we report, a
34-year-old man with a history of high-grade fever, chills, and rigor,
eschar, splenomegaly with the laboratory findings of thrombocytopenia,
hypochromic RBCs with anisocytosis and basophilic stippling, elevated
transaminases, and a positive Weil Felix test along with positive PCR
results for Orientia tsutsugamushi and the presence of IgG and IgM
antibodies. A detailed workup was done to rule out other etiology for
fever. Diagnosis of HLH secondary to Rickettsia infection was made with
a thorough history, clinical evaluation, and a variety of
investigations. The patient was treated with Doxycycline, Ciprofloxacin,
Etoposide, and Dexamethasone but unfortunately, the patient expired
during treatment due to multiorgan failure. Patients with scrub typhus
typically respond well to therapy, therefore early detection and
antibiotic treatment can help avoid serious complications. Scrub typhus
with the hemophagocytic syndrome can result in DIC and multiorgan
failure. Despite its rarity, scrub typhus may be lethal; as a result,
practitioners must be aware of the necessity of detecting and treating
suspected cases as soon as possible. We learned that a systematic
diagnostic approach, use of diagnostic criteria, and prompt treatment
are very crucial in this disease.
Keywords : scrub typhus, Orientia tsutsugamushi ,
hemophagocytosis, hemophagocytic lymphohistiocytosis