Clinical scenario:

A 45-year-old farmer, presented with complaints of fever, chills, generalized weakness associated with yellowish discoloration of sclera for 15 days.

On examination: His vitals were unremarkable, he was febrile at the time of presentation and had Jaundice. Systemic examination revealed hepatosplenomegaly.

Investigations

Hb 12 .3 gm/dl Plt 1 lakh,

Bilirubin 5.4mg/dl

SGOT/SGPT – 160/174, Alp 352, D.

An ultrasound revealed hypoechoic lesions in segment VII and VIII of the liver and also in the spleen ? Metastasis

Later CECT was done which showed – hepatosplenomegaly with hypoechoic lesions in spleen s/o infarct as shown in Fig1 and Fig 2

However, a careful examination of the skin revealed an eschar Fig 3 on the right lateral aspect of the abdomen in the lumbar quadrant.

Further test showed Scrub Ig M 3.52 (positive)

Hospital course

Pt received oral doxycycline following which his symptoms improved. He was discharged and advised to follow up after a month.

Teaching message

Splenic infarcts, commonly seen in brucellosis and melioidosis, can also be seen in scrub typhus as well.

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This case was contributed by

Dr.Rohit Rajeevan,
Asst.Prof,
Dept of General Medicine