Multiple Eschars on Lip in Scrub Typhus

Abstract

Scrub typhus is an endemic disease of Asian Pacific region, affecting about 1 million people every year. Although it remarkably recovers with doxycycline, the mortality in untreated cases may be as high as 40 to 45%. Owing to the lack of diagnostic facilities for scrub typhus in most places, it is very important to recognize the clinical features. A typical eschar is pathognomonic of the disease. However, this is very rare to be found on the face, and hence can lead to confusions. We present the case of a boy who presented three eschars on the upper lip and was diagnosed as a case of scrub typhus. He responded dramatically with intravenous doxycycline and the eschars healed spontaneously over the next 2 to 3 weeks.

Keywords

scrub typhus - eschar - rickettsia

• References

• 1 Taylor AJ, Paris DH, Newton PN. A systematic review of mortality from untreated scrub typhus (Orientia tsutsugamushi). PLoS Negl Trop Dis 2015; 9 (08) e0003971
• 2 Liu Y-X, Cao W-C, Gao Y. , et al. Orientia tsutsugamushi in eschars from scrub typhus patients. Emerg Infect Dis 2006; 12 (07) 1109-1112
• 3 Kim DM, Won KJ, Park CY. , et al. Distribution of eschars on the body of scrub typhus patients: a prospective study. Am J Trop Med Hyg 2007; 76 (05) 806-809
• 4 Kundavaram AP, Jonathan AJ, Nathaniel SD, Varghese GM. Eschar in scrub typhus: a valuable clue to the diagnosis. J Postgrad Med 2013; 59 (03) 177-178