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KMID : 0882420170920030321
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Korean Journal of Medicine
2017 Volume.92 No. 3 p.321 ~ p.325
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Severe Scrub Typhus with Hemophagocytic Lymphohistiocytosis Occurring in Summer
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Ahn Jae-Sung
Noh Jin-Hee
Kim Hyung-Rae
Jung Ji-Won
Jo Jae-Cheol
Lim Ji-Hun
Jun Jae-Bum
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Abstract
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In Korea, scrub typhus usually occurs in October and November. Hemophagocytic lymphohistiocytosis (HLH) is a distinct clinical entity characterized by a high fever, pancytopenia, hepatosplenomegaly, histiocyte proliferation, and hemophagocytosis. We encountered a summertime case of severe scrub typhus presenting as HLH. A 49-year-old female complained of abdominal pain and fever 3 days in duration. On hospital day 3 she was transferred to the intensive care unit because of clinical deterioration accompanied by severe sepsis. As an eschar was evident on the right shoulder, we commenced doxycycline. Her condition improved dramatically and she was discharged on day 14. Although the indirect immunofluorescence antibody test (IFA) for Orientia tsutsugamushi was negative on admission, a repeat IFA test was positive; the antibody titer was 1:5,120 on hospital day 10. Scrub typhus should be considered during differential diagnosis in a patient with severe sepsis in any season except the fall.
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KEYWORD
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Scrub typhus, Lymphohistiocytosis, Hemophagocytic, Summer
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