Scrub Typhus-Induced Macrophage Activation Syndrome with Flare of Systemic Lupus Erythematosus: A Rare Case Report

Debroop Sengupta *

Department of General Medicine, Institute of Post Graduate Medical Education & Research, Kolkata, India.

Upamanyu Bag

Department of General Medicine, Institute of Post Graduate Medical Education & Research, Kolkata, India.

Kamal Poddar

Department of General Medicine, Institute of Post Graduate Medical Education & Research, Kolkata, India.

Aakash Guha Roy

Institute of Post Graduate Medical Education & Research, Kolkata, India.

Shramana Sarkar

Institute of Post Graduate Medical Education & Research, Kolkata, India.

Sandip Ghosh

Department of General Medicine, Institute of Post Graduate Medical Education & Research, Kolkata, India.

Shantasil Pain

Department of General Medicine, Institute of Post Graduate Medical Education & Research, Kolkata, India.

*Author to whom correspondence should be addressed.


Abstract

Aims: Infection is a major trigger for both Lupus flare and Macrophage activation syndrome. Scrub typhus infection associated with lupus flare or MAS has been very rarely reported. We report a case of scrub typhus-induced MAS along with a flare of disease activity in a neuropsychiatric lupus patient presenting after discontinuation of medications.

Presentation of Case: 13-year-old girl, a known case of neuropsychiatric lupus with lupus nephritis, on immunosuppressant for the last 1 year had stopped all medications for 3 months. She had presented with a fever and altered sensorium. Based on clinical and laboratory investigations, a diagnosis of scrub typhus-induced macrophage activation syndrome with a flare of lupus disease activity was made and the patient was treated with injection doxycycline and glucocorticoids. There was rapid clinical improvement with treatment.

Discussion: The case emphasizes the importance of identifying the exact trigger behind the deterioration of a patient with lupus and its therapeutic implications. An infection alone requires antibiotics only, flare without infection requires up titrating immunosuppressants but the presence of life-threatening complications like MAS along with infection requires prompt treatment of both facets simultaneously.

Conclusion:  Scrub typhus infection should be ruled out apart from other common infections in any patient with lupus flare or MAS.

Keywords: Scrub typhus, macrophage activation syndrome, systemic lupus erythematosus, lupus


How to Cite

Sengupta, Debroop, Upamanyu Bag, Kamal Poddar, Aakash Guha Roy, Shramana Sarkar, Sandip Ghosh, and Shantasil Pain. 2022. “Scrub Typhus-Induced Macrophage Activation Syndrome With Flare of Systemic Lupus Erythematosus: A Rare Case Report”. Asian Journal of Research in Infectious Diseases 11 (3):1-5. https://doi.org/10.9734/ajrid/2022/v11i3217.

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