Encephalomyelitis as the first manifestation of scrub typhus

Scrub typhus is a zoonotic disease caused by Orientia tsutsugamushi. We report here a middle-aged man with 3 days history of mild fever, dysphagia, and anarthria. On examination, he had nystagmus, quadriparesis, and a fresh eschar in the left scrotal region. Cerebrospinal fluid (CSF) and serum samples were positive for tsutsugamushi antibody. The magnetic resonance images (MRIs) showed T2 lesions in the brainstem, basal ganglia, frontal, corona radiate and spinal cord. After treatment with chloramphenicol and prednisolone, the clinical symptoms and signs improved. Our case highlights that encephalomyelitis may be caused by rickettsial disease such as scrub typhus.