Scrub Typhus with Guillain-Barré Syndrome: An Atypical Sequela due to Delayed Diagnosis

Scrub typhus is a zoonotic infection which is endemic to the tropical regions of South-East Asia including the sub-Himalayan belt of North India. Clinical manifestations of scrub typhus range from self-limiting acute febrile illness to sometimes fatal multi- organ involvement. However, it does not usually involve the central nervous system, if affected meningoencephalitis is the most common presentation. Hereby the authors report a 60-year-old patient of scrub encephalitis who developed acute onset ascending, symmetric flaccid quadriparesis with sensory involvement. Electrophysiological studies and demonstration of antiganglioside antibodies confirmed the diagnosis of AMSAN variant of Guillain-Barré syndrome. The patient was treated successfully with five days of intravenous immunoglobulins. She became ambulatory with complete recovery four weeks after discharge. Guillain-Barré syndrome is a treatable entity and should be evaluated in all cases of scrub typhus having a similar presentation. It can lead to a diagnostic challenge that can often be missed as it is a rare presentation of scrub infection. Therefore, prompt diagnosis and treatment is necessary for better outcomes.