Abstract
We report a case of scrub typhus with coexistent Pseudomonas aeruginosa skin infection in the same patient. A 6-year-old Chinese boy presented with 5 days
of fever, 2 days of right thigh swelling, and an insect bite mark over the swelling.
A full blood count had been performed prior to hospital consultation, and showed neutropenia
and thrombocytopenia. Initial clinical examination revealed a tender erythematous
induration with a central punctum on his right thigh, which progressed to form a rolled-up
papule with black central necrosis. The clinical suspicion was of an eschar, although
ecthyma gangrenosum could not be ruled out. He had recently returned from a recreational
trip in the United States 3 weeks earlier, and had travelled to Wisconsin and Las
Vegas. He was treated initially for right thigh cellulitis with parenteral ampicillin
and cloxacillin, but after infectious disease consultation, he was commenced on intravenous
ciprofloxacin. A wound culture grew P. aeruginosa, while rickettsial serology was positive for Orientia tsutsugamushi. He responded clinically to ciprofloxacin and was discharged well, and an outpatient
review showed significant improvement of his cutaneous lesion.
Keywords
eschar - ecthyma gangrenosum -
Pseudomonas aeruginosa
- scrub typhus - ciprofloxacin
