From fever to fundus: Scrub typhus presenting with cerebral venous sinus thrombosis and papilledema

Abstract

Scrub typhus, caused by Orientia tsutsugamushi , is a common rickettsial infection in Asia. The neurological manifestations of the disease are well noted; however, vascular complications like cerebral venous sinus thrombosis (CVST) are rare. Early recognition is important, as CVST can lead to raised intracranial pressure and vision-threatening complications. A 38-year-old previously healthy female presented with fever, headache, and vomiting. Ophthalmic examination revealed Grade 2 papilledema with preserved visual acuity. Magnetic resonance imaging of the brain and magnetic resonance venography demonstrated findings suggestive of CVST. Lumbar puncture showed elevated opening pressure (280 mmH ₂ O) with normal cerebrospinal fluid parameters. Infectious workup was negative except for a positive scrub typhus immunoglobulin M enzyme-linked immunosorbent assay. The patient was managed with doxycycline, anticoagulation therapy, and intravenous mannitol, resulting in rapid clinical improvement and resolution of papilledema. Early diagnosis and prompt initiation of antimicrobial and anticoagulation therapy can result in excellent visual and neurological outcomes.