How should scrub typhus and lupus be managed together?

Question

Hello doctor,

Scrub typhus has been confirmed, and lupus is making everything chaotic. I stopped Plaquenil because my liver numbers are high. How risky is that? I have developed unusual chest pain and breathing issues; could this be due to typhus or a lupus flare? I am also experiencing double vision and confusion. Do I need an MRI? My platelets are at 28,000. Is it safe to continue taking Aspirin? How should we manage both conditions together?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

Your situation is high-risk because both scrub typhus and lupus can cause severe multi-organ complications. Scrub typhus can lead to myocarditis (inflammation of the heart muscle), pneumonitis (inflammation of the lungs), or encephalitis (inflammation of the brain). On the other hand, a lupus flare can result in central nervous system (CNS) involvement, vasculitis (inflammation of blood vessels), or worsening thrombocytopenia (low platelet count). Additionally, scrub typhus can cause liver dysfunction, and lupus or its medications may exacerbate liver issues.

Temporarily stopping Plaquenil is reasonable due to elevated liver enzymes, but lupus flares could worsen without it. Steroid bridging may be necessary if a flare is suspected, and liver enzymes should be monitored regularly. If liver function improves, restarting Plaquenil is recommended. Given your symptoms of confusion and double vision, an immediate MRI (magnetic resonance imaging) is essential to rule out encephalitis or vasculitis. Avoid Aspirin until your platelet count rises above 50,000, as it increases bleeding risks. Continue taking Doxycycline or Azithromycin and monitor your condition closely. If your symptoms worsen, you should seek immediate medical attention. Kindly consult your doctor and take medicines accordingly.

I hope this helps.

Thank you.