CASE REPORT Scrub typhus as a possible aetiology of Guillain–Barre ´ syndrome: two cases M.-S. Lee Æ J.-H. Lee Æ H.-S. Lee Æ H. Chang Æ Y.-S. Kim Æ K.-H. Cho Æ S.-H. Ahn Æ J.-H. Song Æ M. Yoo Æ J.-K. Han Æ H.-Y. Park Received: 6 January 2008 / Accepted: 10 September 2008 / Published online: 16 October 2008 Ó Royal Academy of Medicine in Ireland 2008 Abstract Neurological complications of scrub typhus are reported to be rare. Peripheral nervous system involvement has been reported in only one case. We present two cases of Guillan–Barre ´ syndrome (GBS) associated with scrub typhus. In both cases, the findings of an elevated indirect immunofluorescent antibody titer for Orientia tsutsuga- mushi and nerve conduction study showing sensory-motor polyneuropathy, have led us to believe that scrub typhus could be one of the antecedent illnesses associated with GBS. Keywords Scrub typhus Á Guillan–Barre ´ syndrome Abbreviation GBS Guillain–Barre ´ syndrome Introduction Scrub typhus is an acute febrile illness caused by Orientia (formerly Rickettsia) tsutsugamushi, an arthropod borne obligate intracellular gram negative organism that targets vascular endothelial cells [1]. It is endemic in areas of South East Asia, Japan, Australia and the Pacific islands. Neurological manifestations, most often meningoencepha- litis, have been described in this illness [2]. Recently, a case of Guillain–Barre ´ syndrome (GBS) was seen in association with scrub typhus [3]. We report two further similar cases. Case presentation Patient 1 A 54-year-old man presented with 15 days history of fever, myalgia in November. The body temperature was 38.1°C on admission. He did not take any antibiotics or antipy- retics. He did not have any respiratory symptoms (cough, sputum, coryza, or sore throat), and his past medical history was negative for any respiratory infection. He did, how- ever, work on a rice field 20 days prior to presentation. Upon physical examination, an eschar was found on the lateral aspect of the patient’s right ankle (Fig. 1). The patient was not found to have a rash, lymph nodes enlargement or hepatosplenomegaly. The patient was alert and oriented for time, place and person. Laboratory results showed WBC of 7,180/mm 3 (4–10 9 10 3 /mm 3 ), Hemo- globin of 8.7 g/dL (12–16 g/dL), PLT of 23.6 10 4 /mm 3 (15–45 9 10 4 /mm 3 ), LDH of 771 IU/L (100–450 IU/L), AST/ALT 178/80 IU/L (5–35/5–40 IU/L), total bilirubin of 3.3 mg/dL (0.2–1.4 mg/dL), BUN/Cr 9/0.5 mg/dL M.-S. Lee Á J.-H. Lee Á S.-H. Ahn Á J.-H. Song Department of Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, 344-2 Shinyong-dong, Iksan, Jeonbuk 570-180, South Korea H.-S. Lee Á H. Chang Á Y.-S. Kim Á K.-H. Cho Á H.-Y. Park (&) Department of Neurology, Wonkwang University Hospital, Wonkwang University School of Medicine, 344-2 Shinyong-dong, Iksan, Jeonbuk 570-180, South Korea e-mail: hypppark@hanmail.net M. Yoo Department of Medicine, Public Health Center, Inchon, South Korea J.-K. Han Department of Physical Education, Chung-Ang University, Seoul, South Korea 123 Ir J Med Sci (2009) 178:347–350 DOI 10.1007/s11845-008-0226-z