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Open Access Case report

Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure

Bor-Jen Lee25, Chia-Yi Chen134, Sung-Yuan Hu1346*, Yu-Tse Tsan1347, Tzu-Chieh Lin1347 and Lee-Min Wang134

Author Affiliations

1 Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City, 00407, Taiwan

2 Intensive Care Unit, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, 00407, Taiwan

3 Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan

4 School of Medicine, Chung Shan Medical University, Taichung City, 40201, Taiwan

5 School of Nutrition and Institute of Nutritional Science, Chung Shan Medical University, Taichung City, 40201, Taiwan

6 National Taichung Nursing College, Section 1, San Min Road, Taichung City, Taiwan

7 National Taiwan University, Taipei, 10617, Taiwan, China

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BMC Infectious Diseases 2011, 11:79  doi:10.1186/1471-2334-11-79

Published: 30 March 2011

Abstract

Background

Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed.

Case presentations

We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days.

Conclusion

Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.