What is the treatment for scrub typhus in an MS patient?

Question

Hi doctor,

I am a 38 year old female. I have scrub typhus and multiple sclerosis. My treatment complicated everything. I have stopped Ocrevus because of a fever (102.6 degrees Fahrenheit) and now my left side is numb. I have a weird black bite mark on my leg. My rashes are spreading, and I have blurry vision. What are the complications of scrub typhus in MS patients?

Please help me.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

This is an emergency as both scrub typhus complications and multiple sclerosis (MS) relapses could be causing your symptoms. I suggest the following for your treatment.

For scrub typhus management you can start Doxycycline immediately (unless contraindicated) after consulting your specialist doctor. Fever and rash are likely from the infection. Untreated, scrub typhus can cause neurological complications like encephalitis or vasculitis. Monitor for organ involvement (liver, kidney, and brain) with laboratory tests and imaging.
Stopping Ocrevus (Ocrelizumab) increases the risk of an MS relapse. The numbness, vision issues, and balance loss suggest a relapse. A neurologist may consider high-dose intravenous steroids (Methylprednisolone) to control inflammation, balancing infection risks.
Brain MRI (magnetic resonance imaging) can be done to check for new MS lesions.
CSF (cerebrospinal fluid) analysis can be done If there is a concern for central nervous system involvement from scrub typhus (encephalitis).

You need to get admitted to a hospital for intravenous antibiotics, MS treatment, and monitoring for complications like respiratory failure or seizures. Call your MS specialist and infectious disease doctor immediately in case of worsening symptoms. This dual issue requires close monitoring in a hospital setting.

I hope this information helps you.

Feel free to ask further queries.

Thank you.