Indian Journal of Clinical Anaesthesia 2023;10(2):218–219 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Clinical Anaesthesia Journal homepage: www.ijca.in Letter to Editor Guillain – Barre syndrome with no known etiology: Rule out scrub typhus Deepak Kumar Daunaria 1 , Deepak Singla 1, *, Tiajem Jamir 1 1 All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India ARTICLE INFO Article history: Received 08-05-2023 Accepted 09-05-2023 Available online 05-06-2023 This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com Sir, We report a case of Guillain – Barre Syndrome (GBS) in a 48-year-old, male farmer with no known comorbidities. He presented with a history of fever for ten days, diarrhoea for eight days, weakness in all four limbs for four days and heaviness in the chest for two days. He got admitted to the ICU for inability to walk without aid and poor cough reflex. The patient was conscious and oriented. He did not have any eschar nodule, rash, lymphadenopathy, or hepatosplenomegaly on physical examination. Neurological examination revealed right facial paralysis, with 2/5 motor power on the bilateral lower limbs with normal sensations in all four limbs. The deep tendon reflexes were absent in lower limbs with negative Babinski’s sign and Hoffman’s sign. Kernig sign and Brudzinski sign were absent. Baseline investigations, blood cultures and acute febrile illness workup were normal. On nerve conduction study slowed conduction velocity and prolonged distal latencies were noted. Electrophysiologic studies showed demyelinating patterns of motor neuropathies. Cerebrospinal fluid (CSF) examination revealed mild pleocytosis (10 cells/mm3) and increased protein (227 mg/dl). Since blood investigations and culture reports were normal. We sent work up for scrub typhus as it was endemic in the area and patient was a farmer though no eschar was detected. Scrub typhus rapid antibody test detected scrub typhus IgM antibody (Figure 1). He was intubated because of the poor cough * Corresponding author. E-mail address: sngladpk@gmail.com (D. Singla). reflex and decreased respiratory efforts and was started on antibiotics (Doxycycline and ceftriaxone) for scrub typhus and intravenous immunoglobulin (400mg/kg/day) for five consecutive days for GBS. The patient was tracheostomized because of the need for prolonged mechanical ventilation. Gradually, his muscle power improved for which he was put on T-piece and weaned off the ventilator on day 21 of ICU. Fig. 1: Scrub typhus rapid antibody test report Scrub Typhus caused by a bacteria called Orientia tsutsugamushi (O. tsutsugamushi). 1 It is a systemic illness that causes generalized vasculitis in the affected individuals. Disease is acquired by bite of infected chiggers (larval mites), 2 especially in rural areas. O. tsutsugamushi infection is characterized by fever, head ache, body ache, lymphadenopathy, rash and eschar, though all these features may not be present in all cases. 2 Severe cases if left https://doi.org/10.18231/j.ijca.2023.046 2394-4781/© 2023 Author(s), Published by Innovative Publication. 218