Weekly Chest CasesArchive of Old Cases

Case No : 1311 Date 2022-12-05

  • Courtesy of Kyung Hee Lee / Bundang Seoul National University Hospital
  • Age/Sex 83 / M
  • Chief ComplaintCC: chest pain, fever (onset: 1 day ago), PMHx: HTN, dyslipidemia, Occupation: farmer, Physical examination: right axillary eschar
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Scrub typhus (tsutsugamushi disease)
Radiologic Findings
Diffuse interlobular septal and bronchovascular thickening and mild GGOs in both lung.
Bilateral pleural and pericaridal effusion.

Brief Review
Acute febrile illness caused by Orientia tsutsugamushi
Focal or disseminated vasculitis and perivasculitis
Multiorgan involvement: lungs, heart, liver, spleen, and CNS
Humans infected by bite of larval-stage chigger or trombiculid mite
Activity in mite-infested habitats (brush and grass), late fall (Oct–Nov)
PE: eschar at wound site, general/regional lymphadenopathy, maculopapular rash, splenomegaly
Autopsy: interstitial pneumonia (almost), myocardial lesions (80%)
Microscopy: blood vessels congested and surrounded by mononuclear cellular infiltration, interlobular septa and alveolar walls show edema and cellular infiltration

Chest x-ray
Bilateral diffuse reticulonodular opacity, hilar lymph node enlargement, septal line
Pleural effusion (common), airspace consolidation (uncommon)
Cardiomegaly (reversible)

Chest CT
Interlobular septal thickening, axial interstitial thickening, GGO, centrilobular nodules
Lower zone predominance
Mediastinal and axillary lymphadenopathy
References
RadioGraphics 2007; 27:161–172, Clinical Radiology 2000; 55:140–144, Korean Radiol Soc 1996; 36:987–990
Keywords
Scrub Typhus (Tsutsugamushi disease) ,

No. of Applicants : 96

▶ Correct Answer : 79/96,  82.3%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Hospital of Sacred Heart, Montreal , Canada ANDREA OJANGUREN
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Other , Korea (South) HWANGHEE JO
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - Chungbuk National University Hospital , Korea (South) JIYUN KANG
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Ajou University Hospital , Korea (South) KYUNGMIN LEE
  • - Other , Korea (South) SEONGSU KANG
  • - Scans world , India PHILSON JOSEPH MUKKADA
  • - , Korea (South) JIN YOUNG LEE
  • - , China FANG YING GEN
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - The first affiliated Hospital of Xiamen University , China Qing Qiang Guo
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Osaka Metropolitan University , Japan HIROTAKA TAKITA
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - , Korea (South) MINJI KIM
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yamanashi Prefectural Central Hospital , Japan HIROAKI WATANABE
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - , Korea (South) HYOUNG YEOB KIM
  • - Asan Medical Center , Korea (South) JIEUN KIM
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , United Arab Emirates NEHAR RANJAN CHAKRABORTY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Other , Korea (South) SEONG WON JANG
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Manipal hospital Hebbal ,Bengaluru , India PRAVIN KUMAR M
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - Ulsan University Hospital , Korea (South) SUNGMIN KIM
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Other , Korea (South) KYU-CHONG LEE
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Gyeongsang National University Hospital , Korea (South) BYEONG JU KOO
  • - , Japan YUMI MAEHARA
  • - , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - , Korea (South) WONJU HONG
  • - , Korea (South) HM PARK
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 1/96,  1.0%
  • - Mie University Hospital , Japan KENSUKE DOMAE
▶ Semi-Correct Answer : 4/96,  4.2%
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - , Japan HIKARI FUKUI
  • - , Japan KENTARO KOTANI
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
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