Opsoclonus-Myoclonus Syndrome Associated with Scrub Typhus

Choi, You Jin; Choi, Seo Young; Choi, Jae-Hwan; Choi, Kwang-Dong

Research in Vestibular Science > Accepted Articles

You Jin Choi¹, Seo Young Choi¹, Jae-Hwan Choi², Kwang-Dong Choi¹

¹Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
²Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

Correspondence

Kwang-Dong Choi ,Tel: +82-51-240-7317, Fax: +82-51-240-7828, Email: kdchoi@pusan.ac.kr

Received: November 1, 2016; Accepted: January 13, 2017. Published online: January 13, 2017.

ABSTRACT

Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus-myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15-20° and a frequency of 6-8Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and CSF analysis revealed pleocytosis. Brain MRI was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.

Keywords: Opsoclonus-myoclonus syndrome; scrub typhus; encephalitis