Case Report
 
Scrub typhus vasculitis causing pan-digital gangrene
Suja Lakshmanan1, Krishnamoorthy Seetharaman1, Ramakrishnan SR2, Sathiyan Sivanandam3, Koushik AK4
1MD Gen Med,Assistant Professor, Department of Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
2MD Gen Med, Professor, Department of Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
3DM Nephrology, Assistant Professor, Department of Nephrology, Sri RamachandraMedical College and Research Institute, Chennai, Tamil Nadu, India.
4MD Gen Med, Post Graduate, Department of Medicine, Sri Ramachandra Medical College and Research Institute, Chennai, TamilNadu, India.

doi:10.5348/ijcri-201569-CR-10530

Address correspondence to:
Suja Lakshmanan
40/23 Kamdar Nagar 1st Street
Mahalingapuram, Nungambakkam, Chennai
Tamil Nadu 600034
India
Phone: +91-9940135101

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How to cite this article
Suja L, Krishnamoorthy S, Sathiyan S, Sivanandam S, Koushik AK. Scrub typhus vasculitis causing pan digital gangrene Int J Case Rep Images 2015;6(7):416–421.


Abstract
Introduction: Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi. Farmers account for approximately two-thirds of all reported cases. Incidence rates are highest in people aged 40 to 60 years. The severity of infection can range from mild symptoms and signs to multi-organ failure. The chief target of the organism is the vascular endothelium of various organs. There is inflammation in and around the blood vessels that causes endothelial damage resulting in vascular leakage and organ dysfunction.
Case Report: A 62-year-old female, farmer by occupation who presented to us with features of acute respiratory distress syndrome (ARDS) and meningitis, subsequently developed gangrene of digits of all four limbs. We investigated the patient for infectious and non-infectious causes of vasculitis leading onto gangrene. We attributed the cause for pan-digital gangrene as scrub typhus as evidenced by the presence of eschar and positive serology. Patient recovered with ventilatory support and antibiotics though her digits could not be salvaged which was managed conservatively.
Conclusion: While going through literature we observed that there were no case reports of gangrene caused by scrub typhus. Pan-digital gangrene is an unusual complication of scrub typhus. Hence scrub typhus has to be ruled out in patients presenting with this complication.

Keywords: Pan-digital gangrene, Scrub typhus, Vasculitis


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Author Contributions
Suja Lakshmanan – Conception and design, Acquisition of data, Analysis and interpretation of data,Drafting the article, Critical revision of the article and Final approval of the version to be published
Krishnamoorthy Seetharaman – Conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Critical revision of the article and Final approval of the version to be published
Ramakrishnan SR – Analysis and interpretation of data, Critical revision of the article and final approval of the version to be published
Sathiyan Sivanandam – Conception and design, Analysis and interpretation of data, Drafting the article, and Final approval of the version to be published
Koushik AK – Acquisition of data, Critical revision of the article and Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
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Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Suja Lakshmanan et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

L. Suja is Assistant Professor in Sri Ramachandra Medical College and Research Institute, Chennai, India. She is interested in the field of autoimmune disorders.



Krishnamoorthy Seetharaman is Assistant Professor in Sri Ramachandra Medical College and Research institute, Chennai, India. He earned his undergraduate degree from Calicut Medical College, Calicut University, Calicut Kerala, India and postgraduate degree from Stanley Medical College, Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India. He has published one research paper in a national journal. His interest include detailed evaluation of rare and interesting cases, comprehensive management of each patient and delivering lectures in various forum.



Ramakrishnan SR is Professor in Sri Ramachandra Medical College and Research institute, Chennai, India. He earned undergraduate and postgraduate degree from Stanley Medical College, Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India. His research interest is on diabetes mellitus.



Sathiyan Sivanandam is Assistant Professor in Sri Ramachandra Medical College and Research Institute, Chennai, India. He earned undergraduate degree from PSG medical college, Coimbatore, Tamil Nadu, India and post graduate degree from Madurai Medical College, Tamil Nadu Dr MGR Medical University, Madurai, Tamil Nadu, India. He did his super specialization in nephrology at Madras medical college, Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India. He is interested in renal transplantation and clinical nephrology



Koushik AK is a postgraduate in Sri Ramachandra Medical College and Research institute, Chennai, India. He has published a couple of case reports in the national journals.