We here present a case of scrub typhus (ST) manifesting with hemiparesis, which, to the best of our knowledge, has been reported few times prior. ST typically presents with headache, fever, cough, dyspnoea, and/or gastrointestinal symptoms. Early treatment ensures swift improvement. However, this common cause of febrile illness is often overlooked, even in endemic regions. This is due to a nonspecific presentation, low index of suspicion, and lack of diagnostic facilities. Even our institution, an apex public referral center of northern India, lacked affordable testing a decade ago. After testing began, a significant number of cases, which would have previously been labeled as “fever of unknown origin,” were found to be of ST and confirmed by response to doxycycline.

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Con icts of interest
There are no con icts of interest.
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(a‑c) Restricted diffusion on the right‑sided temporo‑parieto‑occipital
cortex on diffusion‑weighted imaging, suggestive of encephalitis (arrows).
(d and e) Leptomeningeal enhancement on an axial section of contrast‑enhanced
brain MRI, suggestive of meningitis (arrows)
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Syed F Abbas, Ahmad Ozair, Vivek Kumar,
D Himanshu
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