Eschar of Scrub Typhus Hidden in Umbilicus

Excerpt

A 7-y-old girl was referred to authors for fever, vomiting and pain abdomen of 7 d. She had tachycardia, tachypnea and tender axillary and inguinal lymphadenopathy. On respiratory system examination, dull percussion note, bronchial breath sounds and crackles were heard in left lower chest. Abdominal examination revealed hepato-splenomegaly and ascites. Routine laboratory reports revealed anemia (Hb 9.33 g%), thrombocytopenia (Platelet count 57,000/mm³), elevated hepatic transaminases (AST 100 IU/L, ALT 64 IU/L) and sterile cultures of blood and urine. Tests for malaria, dengue fever, enteric fever and HIV were negative. Chest X-ray showed left sided non homogenous opacity with air bronchograms suggestive of consolidation. An eschar (missed on initial examination) was seen hidden under upper skinfold of umbilicus (Fig. 1). An IgM ELISA test (Scrub typhus detect™, In BiOS International, Seattle USA) for scrub typhus was sent (reported positive later) and the child was started on intravenous azithromycin. She responded dramatically, became afebrile in 36 h and was discharged after 7 d following normalisation of clinical and laboratory parameters.

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