A case of scrub typhus with massive bleeding from duodenal polyp after therapeutic recovery

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  • 治療回復後に十二指腸ポリープからの大量出血を生じたツツガムシ病の1例

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<p>A fifties man with no relevant medical history was transferred to our emergency departmentbecause of dyspnea, general malaise, and anorexia that began 7 days before.　He was diagnosed withseptic shock and hospitalized.　Administration of vasopressors and antimicrobials did not improve hiscondition, and he was referred to our department for further investigation and management the day afteradmission.　On physical examination, in addition to fever and erythematous rash, an eschar was noted atthe right armpit.　Scrub typhus was strongly suspected.　Laboratory tests showed thrombocytopeniaand hypofibrinogenemia, indicating disseminated intravascular coagulation （DIC）.　The administrationof minocycline improved his condition, but DIC persisted.　On the fifth day, he developed gastrointesti-nal hemorrhagic shock, and the endoscopic examination revealed bleeding from a duodenal polyp.　Endoscopicclipping was performed, but hypotension and DIC were sustained.　On the seventh day,emergency polypectomy was performed, and his condition improved.</p><p>Some patients with scrub typhus lead to severe disease caused by vasculitis without temporal recovery,resulting in systemic complications.　Gastrointestinal bleeding is one of the rare complications.　Our case had prolonged coagulation abnormalities despite therapeutic recovery and developed bleedingfrom a duodenal polyp for which endoscopic polypectomy was required.　Histopathological examinationof the polyp specimen revealed no vasculitis.　Therefore, the cause of bleeding was considered due toprolonged coagulation abnormalities, not due to vasculitis, which was reported to be a typical feature ofgastrointestinal bleeding in patients with scrub typhus.　The complication of gastrointestinal bleeding inpatients with scrub typhus should be cautioned even after the patient's condition has recovered when thecoagulation abnormalities persist.</p>

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