Scrub typhus associated with systemic lupus erythematosus: a case report

ABSTRACT

The etiology of systemic lupus erythematosus [SLE] is largely unknown and there is a probable contribution of genetic, hormonal, immunological and environmental factors for its manifestation. The widespread immunological destruction of many organs in SLE and the associated decreased immunity increase the risk of infections. Steroids and other immunosuppressant are important in the treatment of SLE, but they further increase the risk of infections, and sometimes with rare organisms. We present a case of an adolescent girl with prolonged fever, joint pains and without skin rashes. The initial diagnosis was SLE. She was treated with steroids with improvement in her general condition and relief of joint pains. However the fever persisted and subsequent investigations revealed an associated scrub typhus. The fever subsided after treatment with oral tetracycline. There were no complications of scrub typhus. Since scrub typhus infection is not common in the Arabian Peninsula the disease was not initially thought of. In the investigation of prolonged fever in SLE, viral, bacterial, protozoal as well as rickettsial diseases should be borne in mind