SHM Converge Scientific Abstract ePoster Gallery-From Conundrum to Clarity; A Diagnostic Journey

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This case report describes a previously healthy 25-year-old woman who presented with two weeks of myalgia, high fever, and pain in her palms and soles, then rapidly deteriorated into toxic metabolic encephalopathy, cardiomyopathy, pulmonary edema, thrombocytopenia, and respiratory failure requiring intubation and vasopressor support. Initial evaluation raised concern for pulmonary embolism, but CTA instead showed severe pulmonary edema and cardiomegaly. Despite broad infectious workup, blood cultures, lumbar puncture, viral testing, and autoimmune studies being negative, her condition worsened with shock, headache, transaminitis, and marked inflammatory markers.<br /><br />A next-generation microbial DNA sequencing test identified Rickettsia typhi, along with Bacteroides vulgatus and Bacteroides fragilis. The patient likely acquired murine typhus from flea exposure in a rural Iowa home with unvaccinated outdoor pets. She was treated with doxycycline for R. typhi and metronidazole for the Bacteroides species, leading to rapid defervescence and clinical improvement.<br /><br />The report highlights that murine typhus can present with severe multisystem disease, including neurologic, cardiac, hepatic, hematologic, and pulmonary involvement, and may be difficult to diagnose with routine testing. It emphasizes the importance of maintaining suspicion for uncommon pathogens and considering advanced molecular diagnostics when standard workup is unrevealing.

Asset Subtitle

Bethany J. King

Meta Tag

Author List Aneesa Afroze, Bethany J. King, Garrett Wilt, Kindra Holsing, Madalyn Elliott, Valentina Gomez

Category Clinical Vignettes

Concept Murine Typhus

Concept Doxycycline

Concept Fever

Concept Neurologic Deficit

Concept PCR-based Microbial DNA Sequencing

Distinguished Non-Finalist

Presenter Organization MercyOne Des Moines

Presenting Author Bethany J. King

Track Adult

Keywords

murine typhus

Rickettsia typhi

doxycycline

metagenomic sequencing

toxic metabolic encephalopathy

cardiomyopathy

pulmonary edema

thrombocytopenia

flea exposure

multisystem disease

Murine Typhus

Doxycycline

Fever

Neurologic Deficit

PCR-based Microbial DNA Sequencing