Scrub typhus associated hepatic dysfunction and abdominal CT findings

Abstract

Objective: This retrospective study investigated abnormal hepatic dysfunction and abdominal computed tomography (CT) findings in scrub typhus.

Methods: Three hundred forty nine adult patients were diagnosed with scrub typhus. Ninety four underwent abdominal CT. The CT images were reviewed by the attending radiologist. Patient data of history, symptoms, signs, and results of laboratory tests were collected from the electronic medical records.

Results: In 349 patients with scrub typhus, elevation of aspartate aminotransferase (78.5%) and alanine aminotransferase (63.0%) were dominant compared to alkaline phosphatase (27.2%) and total bilirubin (16.1%). Abdominal CT findings of 94 patients were, in descending order of frequency, enlarged lymph node (53.2%), inhomogeneous enhancement of liver (47.9%), splenomegaly (46.8%), ascites (28.7%), low attenuation of periportal areas (27.7%), gallbladder wall thickening (17.0%), and splenic infarct (6.4%). Also, the level of aspartate aminotransferase tended to be elevated according to the number of CT findings (P= 0.028).

Conclusions: We found that abdominal CT manifestations of scrub typhus with elevated aminotransferases were varied and not specific. However, knowledge of these findings may evoke the recognition of scrub typhus by clinicians in endemic areas.

Keywords: Computed tomography; Hepatitis; Orientia tsutsugamushi; Scrub typhus.

Fig.1

Scrub typhus in a 43-year-old woman. Arterial phase dynamic CT images show mild inhomogeneous enhancement of the hepatic parenchyma as well as splenomegaly.

Fig.2

Scrub typhus in a 67-year-old woman. Serial contrast-enhanced abdominal CT images shows gallbladder wall thickening and splenomegaly.