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, D., Bag, U., Poddar, K., Roy, A. G., Sarkar, S., Ghosh, S., & Pain, S. (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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