Leukocytoclastic Vasculitis: A peculiar presentation of scrub typhus

Abstract

Scrub typhus is a disease endemic to the Indian subcontinent caused by the obligate intracellular pleomorphic organism, Orientia tsutsugamushi. Scrub typhus, among other acute febrile illnesses, manifests as prodromal symptoms of fever, malaise, myalgia and anorexia followed by a distinct maculopapular rash, hepatosplenomegaly and lymphadenopathy. We report the case of a patient presenting to tertiary care hospital in southern India in 2021 who developed a rare cutaneous vasculitis secondary to infection with Orientia tsutsugamushi. After performing the Weil-Felix test, a diagnostic titre of >1:640 against OXK was obtained. Furthermore, a skin biopsy was carried out which confirmed the diagnosis of leukocytoclastic vasculitis. The patient was treated with doxycycline and showed drastic improvement in his symptoms.

Keywords: Doxycycline; India; Rickettsia; Scrub Typhus; Vasculitis.

Figure 1

Image showing multiple, palpable purpuric lesions arranged in a retiform pattern with a dusky necrotic center and peripheral rim of erythema distributed symmetrically over bilateral lower limbs on (A) day 1 and (B) day 3. A close-up view of a skin lesion over the left leg on (C) day 1 and (D) a significant improvement in lesions on day 21.

Figure 2

Haematoxylin and eosin stains at (A) ×100 magnification showing dermis with prominent vasculo-centric infiltrate and (B) ×200 magnification of vessels showing fibrinoid necrosis of vessel walls and dense infiltration of vessel walls by neutrophils with leukocytoclasis.