Acute Disseminated Encephalomyelitis as a Complication of Scrub Typhus in Children

Scrub typhus is a re-emerging threat throughout the world. The spectra of clinical pictures and possible complications are both varied and being increasingly reported. Acute disseminated encephalomyelitis (ADEM) is an infrequent demyelinating disorder of the central nervous system that is precipitated by infections and immunizations. There are only two documented cases of ADEM-associated scrub typhus published in the medical literature. We report the first pediatric case wherein a 5-year-old boy presented with high fever, altered sensorium, seizure, quadriparesis, and neck rigidity. He was ultimately diagnosed as a case of scrub typhus with ADEM. After treatment with intravenous doxycycline and methylprednisolone, the fever subsided but residual neurodeficits, such as inability to sit, stand, and talk, as well as bowel bladder dysfunctions persisted. He was subsequently transferred to long-term rehabilitation care.