Orientia Tsutsugamushi-induced leukocytoclastic vasculitis - A case report

Scrub typhus (also named Tsutsugamushi disease), a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic infectious disease in east Asia and Australia. This disease usually presents as an acute febrile illness with non-specific symptoms. We reported a case of the scrub typhus with leukocytoclastic vasculitis who suffered from acute pyrexia of unknown origin and arthralgia. Weil-Felix test and indirect immunofluorescent antibody technique revealed positive findings. The skin revealed multiple palpable painful purpura on bilateral lower limbs. Histopathology revealed leukocytoclastic vasculitis, and immunoperoxidase study disclosed positive staining of the antibody against 56 kD Rickettsial antigen in involved vascular endothelial cells and perivascular stroma. The patient was treated with doxycycline, and the skin lesions subsided in two weeks. To the best of our knowledge, this is the first proven case of leukocytoclastic vasculitis induced by Orientia tsutsugamushi in Taiwan.