SHM Converge Scientific Abstract ePoster Gallery-A Presentation of Severe Typhus Resulting in Septic Shock

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This case describes severe murine typhus (endemic typhus) caused by <em>Rickettsia typhi</em> in a 41-year-old homeless man with polysubstance use, including recent amphetamine and IV drug use, who presented with 4 days of epigastric abdominal pain, fever, and septic shock. Although murine typhus is usually mild and self-limited, it can become life-threatening without treatment and may involve multiple organ systems, including renal, pulmonary, cardiac, and neurologic complications.

On arrival, the patient was febrile, tachycardic, tachypneic, and profoundly hypotensive. He received 3 liters of IV fluids without improvement and was started on broad-spectrum antibiotics, vasopressors, and admitted to the MICU. Despite escalating to multiple vasopressors and stress-dose steroids, he remained critically ill until doxycycline was started, after which he improved. He also developed anuric acute kidney injury from ATN secondary to shock and required CRRT.

Workup showed splenomegaly on ultrasound, no abdominal source of infection on CT, normal cardiac function on TTE, ferritin >10,000, triglycerides 361, lactate elevation, and a positive <em>R. typhi</em> IgM titer of 1:256. Blood cultures grew <em>Staphylococcus hominis</em>, but the clinical picture favored an infectious typhus syndrome over HLH, though hematology was consulted because of fever, splenomegaly, hypertriglyceridemia, and hyperferritinemia.

The key takeaway is that murine typhus should be considered in patients with high fever, nonspecific symptoms, and shock who do not improve with standard broad-spectrum antibiotics. Early recognition and prompt doxycycline therapy are essential to prevent severe outcomes.

Asset Subtitle

Chanidapa Klinhom

Meta Tag

Author List Chanidapa Klinhom, Darin Poei, Evan J. Chen, Kevin S. Wei, Mollee Chu, Sarah Wang, Vivian H. LeTran

Category Clinical Vignettes

Concept Murine Typhus

Concept Doxycycline

Concept Rickettsia typhi

Concept Sepsis

Concept Clinical Presentation

Distinguished Non-Finalist

Presenter Organization University of Southern California Internal Medicine Residency

Presenting Author Chanidapa Klinhom

Track Adult

Keywords

murine typhus

endemic typhus

Rickettsia typhi

septic shock

doxycycline

acute kidney injury

splenomegaly

hyperferritinemia

homeless patient

critical illness

Murine Typhus

Doxycycline

Rickettsia typhi

Sepsis

Clinical Presentation