Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report
Hyperferritinemia has been associated with increased mortality in severe sepsis and also described with scrub typhus. We describe a case of a 10-year-old child with acute febrile illness, altered sensorium, seizures, and left hemiparesis, along with septic shock. The child had markedly elevated infl...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
|
| Series: | Journal of Pediatric Critical Care |
| Subjects: | |
| Online Access: | http://www.jpcc.org.in/article.asp?issn=2349-6592;year=2022;volume=9;issue=1;spage=27;epage=29;aulast=Gupta |
| _version_ | 1798024227310272512 |
|---|---|
| author | Ajay Gupta Vidya B Ghosh Anil K Singh |
| author_facet | Ajay Gupta Vidya B Ghosh Anil K Singh |
| author_sort | Ajay Gupta |
| collection | DOAJ |
| description | Hyperferritinemia has been associated with increased mortality in severe sepsis and also described with scrub typhus. We describe a case of a 10-year-old child with acute febrile illness, altered sensorium, seizures, and left hemiparesis, along with septic shock. The child had markedly elevated inflammatory markers, along with hyperferritinemia and increased D-dimer. Serological tests for scrub typhus were positive. The child was started on doxycycline along with supportive management. In view of hyperferritinemic sepsis with accompanying cytokine storm, septic shock, and disseminated intravascular coagulopathy, IgM-enriched intravenous immunoglobulin and dexamethasone were administered with good outcome. Neuroimaging revealed cerebral infarcts managed with low-molecular-weight heparin and aspirin. The child was discharged with normal sensorium and with improving left hemiparesis. Early use of immunomodulatory drugs in such atypical presentations in scrub typhus may reduce mortality, and further research is warranted. |
| first_indexed | 2024-04-11T17:59:00Z |
| format | Article |
| id | doaj.art-b9f0a5a3331e4032a65c4f7b145e9b08 |
| institution | Directory Open Access Journal |
| issn | 2349-6592 2455-7099 |
| language | English |
| last_indexed | 2024-04-11T17:59:00Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Pediatric Critical Care |
| spelling | doaj.art-b9f0a5a3331e4032a65c4f7b145e9b082022-12-22T04:10:35ZengWolters Kluwer Medknow PublicationsJournal of Pediatric Critical Care2349-65922455-70992022-01-0191272910.4103/jpcc.jpcc_80_21Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case reportAjay GuptaVidya B GhoshAnil K SinghHyperferritinemia has been associated with increased mortality in severe sepsis and also described with scrub typhus. We describe a case of a 10-year-old child with acute febrile illness, altered sensorium, seizures, and left hemiparesis, along with septic shock. The child had markedly elevated inflammatory markers, along with hyperferritinemia and increased D-dimer. Serological tests for scrub typhus were positive. The child was started on doxycycline along with supportive management. In view of hyperferritinemic sepsis with accompanying cytokine storm, septic shock, and disseminated intravascular coagulopathy, IgM-enriched intravenous immunoglobulin and dexamethasone were administered with good outcome. Neuroimaging revealed cerebral infarcts managed with low-molecular-weight heparin and aspirin. The child was discharged with normal sensorium and with improving left hemiparesis. Early use of immunomodulatory drugs in such atypical presentations in scrub typhus may reduce mortality, and further research is warranted.http://www.jpcc.org.in/article.asp?issn=2349-6592;year=2022;volume=9;issue=1;spage=27;epage=29;aulast=Guptacerebral infarctscytokine stormhyperferritinemiascrub typhus |
| spellingShingle | Ajay Gupta Vidya B Ghosh Anil K Singh Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report Journal of Pediatric Critical Care cerebral infarcts cytokine storm hyperferritinemia scrub typhus |
| title | Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report |
| title_full | Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report |
| title_fullStr | Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report |
| title_full_unstemmed | Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report |
| title_short | Pediatric scrub typhus complicated by cytokine storm, hyperferritinemia, and cerebral infarcts: A case report |
| title_sort | pediatric scrub typhus complicated by cytokine storm hyperferritinemia and cerebral infarcts a case report |
| topic | cerebral infarcts cytokine storm hyperferritinemia scrub typhus |
| url | http://www.jpcc.org.in/article.asp?issn=2349-6592;year=2022;volume=9;issue=1;spage=27;epage=29;aulast=Gupta |
| work_keys_str_mv | AT ajaygupta pediatricscrubtyphuscomplicatedbycytokinestormhyperferritinemiaandcerebralinfarctsacasereport AT vidyabghosh pediatricscrubtyphuscomplicatedbycytokinestormhyperferritinemiaandcerebralinfarctsacasereport AT anilksingh pediatricscrubtyphuscomplicatedbycytokinestormhyperferritinemiaandcerebralinfarctsacasereport |