Successful Treatment of Scrub Typhus - Associated

Scrub typhus is caused by Orientia tsutsugamushi. Any delay in diagnosis can result in delayed treatment and severe complications, including secondary hemophagocytic lymphohistiocytosis, which is rare but potentially fatal. In this paper, the authors present 3 cases of secondary hemophagocytic lymphohistiocytosis associated with scrub typhus, successfully treated with chloramphenicol without additional antineoplastic therapy. All patients cured and achieved complete resolution. This report highlights the effectiveness of chloramphenicol without the need for chemotherapy in the treatment of scrub typhus-associated hemophagocytic lymphohistiocytosis in a pediatric population under the age of 8 years. (Medicine 95(8):e2928) Abbreviations: ARDS = acute respiratory distress syndrome, DIC = disseminated intravascular coagulation, HLH = hemophagocytic lymphohistiocytosis, PHLH = primary hemophagocytic lymphohistiocytosis, SHLH = secondary hemophagocytic lymphohistiocytosis. oucke, MD, PhD, and Ming-Hua Zheng, MD, PhD China, India, Japan, Korea, Taiwan, and others regions in East and South East Asia. A delay in the diagnosis and treatment can result in severe complications, including disseminated intravascular coagulation (DIC), acute respiratory distress syndrome (ARDS), and hemophagocytic lymphohistiocytosis (HLH). HLH is a rare but potentially fatal disease, characterized by a malfunction of natural killer T-cell function, activation and proliferation of lymphocytes or histiocytes with uncontrolled hemophagocytosis and cytokine overproduction. HLH phenotypically presents as 2 different conditions: primary (PHLH) and secondary (SHLH). SHLH has been associated with a variety of stimuli, such as infections, malignant neoplasia, and conditions characterized by immunosuprresion. The SHLH associated with scrub typhus has been reported only in 4 cases (Table 1). Here, we report 3 additional cases from the Southern part of China.