1683Is Neuritis the cause of gastrointestinal hemorrhage in patients with scrub typhus?

Background. Scrub typhus results in vasculitis due to Orientia tsutsugamushi infection. The present study investigated whether O. tsutsugamushi infection is associated with gastric ulcer etiology and whether immunohistochemical staining of stomach tissue is useful to diagnose scrub typhus. Methods. A 78-year-old woman was hospitalized owing to general weakness that begun 4 days prior. As scrub typhus was suspected, doxycycline was administered. On 2 day of hospital admission, the patient had melena and thus underwent an endoscopic examination. Endoscopic findings revealed oozing at the ulcer near the cardia. Endoscopic hemostasis was performed to arrest the bleeding from the ulcer. Five days after admission, the patient exhibited gastric hemorrhage that required emergency total gastrectomy. The stomach tissue subjected to surgery for the scrub typhus gastrointestinal bleeding was immunohistochemically stained with polyclonal antibodies for O. tsutsugamushi. Results. Immunohistochemical staining using the surgical biopsy samples after 5 days of antibiotic administration confirmed the presence of O. tsutsugamushi within the macrophage. The stomach biopsy verified the presence of vasculitis and simultaneously confirmed the neuritis finding. The present study is clinically significant in two aspects. First, the presence of O. tsutsugamushi was confirmed by performing immunohistochemical staining using polyclonal antibodies against O. tsutsugamushi from the stomach tissue of a scrub typhus patient with gastric ulcer bleeding. Patients with unknown causes of gastric bleeding can benefit from the proposed method of immunohistochemical staining to diagnose scrub typhus. Second, the present study is the first to report a neuritis finding in a scrub typhus patient, suggesting the necessity of additional studies to investigate the association between neuritis and gastric ulcer or bleeding. Conclusion. Immunohistochemical staining of stomach tissue is useful to diagnose scrub typhus that causes gastric ulcer. Furthermore, it is the first to confirm the presence not only of vasculitis but also of neuritis during a stomach biopsy of a scrub typhus patient. Further research is needed to confirm neuritis as the causal agent of gastric ulcer and bleeding in scrub typhus. Disclosures. All authors: No reported disclosures.