Scrub Typhus Complicating Interstitial Pneumonitis and Meningoencephalitis: A Case Report

恙蟲病併發間質性肺炎及腦膜腦炎：一病例報告

李文生(Wen-Sen Lee) ； 李垣樟(Wuan-Chan Lee) ； 陳德禮(Te-Li Chen) ； 馮長風(Chang-Phone Fung)

《胸腔醫學》 19卷1期 (2004/02) Pp. 50-54

摘要

恙蟲病是由立克次體引起的急性感染症，自從抗生素問世後，此類疾病所引起的併發症就很少見。罕見的嚴重併發症包括腦膜腦炎、心肌炎、間質性腎炎及間質性肺炎合併急性呼吸窘迫症候群。我們在此報告一位發燒、腹痛、皮疹、意識不清、頸部僵硬及肺部呈現兩側間質性侵潤的患者，腦脊髓液及血清學檢查結果證實為恙蟲病且合併腦膜腦炎及間質性肺炎，此患者經四環素及類固醇治療後，康復出院。能早期診斷及早期治療，對此病的預後影響很重要。此為一臨床少見的個案，特提出討論與文獻回顧。

關鍵字

恙蟲病 ； 腦膜腦炎 ； 間質性肺炎

並列摘要

Scrub typhus is an acute febrile illness. Severe complications of this disease have been very rare since the introduction of specific antibiotic therapy. The most serious clinical manifestations are meningoencephalitis, myocarditis, interstitial nephritis, and pneumonitis with acute respiratory distress syndrome (ARDS). Herein, we report a case of scrub typhus that presented with abdominal pain, fever, rash, altered mental status, and meningismus, and rapidly progressed to bilateral pulmonary infiltrates. The cerebrospinal fluid (CSF) study revealed pleocytosis with predominant lymphocytic cells, hypoglycorrhachia, and an elevated protein level. Blood and CSF cultures for bacteria were negative, but indirect immunofluorescence assay of the serum and CSF for Orientia tsutsugamushi revealed lgG≧640 and lgM≧160. Scrub typhus with meningoencephalitis and interstitial pneumonitis was diagnosed. The patient recovered dramatically after tetracycline and steroid therapy. Early diagnosis and treatment of this disease are important.

並列關鍵字

Scrub typhus ； meningoencephalitis ； interstitial pneumonitis