Opsoclonus: A Rare Neurological Manifestation in a Patient With Scrub Typhus Infection

Abstract

Scrub typhus, prevalent in tropical regions, exhibits a wide range of symptoms, from non-specific signs to severe conditions such as pneumonia, gastroenteritis, lymphadenitis, meningitis, encephalitis, acute kidney injury, and multi-organ dysfunction syndrome. Neurological symptoms like opsoclonus are rarely seen. This report details an unusual case of a 34-year-old male who first complained of high temperature, headache, and sore muscles. Initially treated with antipyretics and oral antibiotics, his symptoms persisted and new ones emerged, leading to an emergency visit with complaints of blurred vision. Upon confirming scrub typhus with opsoclonus, appropriate antibiotics were administered. Persistent fever and opsoclonus prompted suspicion of an atypical infection. A detailed history and investigations, including IgM testing against the scrub typhus antigen, confirmed the diagnosis. Treatment with doxycycline resulted in significant symptom improvement, leading to discharge. This case underscores the need to consider atypical organisms in neurological symptoms, which can be effectively treated with timely diagnosis.

Keywords: neurological manifestations; neurology; nystagmus; opsoclonus; scrub typhus; tropical infections.

Figure 1. Non-contrast CT of the brain shows no significant abnormalities.

Figure 2. Axial T1-weighted MRI of the brain showing normal findings.