How should I treat lupus and scrub typhus?

Question

Hello doctor,

I am a 35-year-old female who has been diagnosed with scrub typhus following a camping trip, and my lupus is also flaring severely. The eschar on my arm has become infected, and the rash looks different from the usual butterfly rash. I had to stop taking Hydroxychloroquine because my liver enzymes were extremely elevated. My fever is 38.5 degrees Celsius (101.4 degrees Fahrenheit), and my kidneys are showing signs of distress with protein in my urine. I am also seeing strange lights and experiencing nosebleeds. My platelet count is only 28,000 per microliter of blood. Please advise as soon as possible.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I sincerely apologize that you have to go through this. Let’s break down your condition:

The presence of an infected eschar and fever suggests worsening scrub typhus. There may be systemic involvement, potentially affecting organs such as the liver and kidneys.
Low platelet count and nosebleeds could indicate disseminated intravascular coagulation (DIC) or other clotting disorders.
The rash you are experiencing, along with protein in your urine and extremely elevated liver enzymes, could be indicative of active lupus nephritis. While stopping Hydroxychloroquine was necessary due to liver damage, it may have exacerbated the flare.
Experiencing visual disturbances, such as seeing strange lights, could suggest central nervous system involvement. This may be related to active lupus (neuropsychiatric lupus) or scrub typhus (scrub typhus encephalitis).

After reviewing your symptoms, I strongly recommend that you go to the hospital immediately. Your condition is complex and requires close monitoring of your liver, kidneys, and platelet levels.

Ensure that you are receiving treatment for scrub typhus, such as Doxycycline or Azithromycin. The doses may need to be adjusted based on your organ function.

You may require intravenous steroids for your lupus flare, and for your low platelet count, a platelet transfusion might be necessary.

Please also have tests done to rule out disseminated intravascular coagulation (DIC), including prothrombin time/international normalized ratio (PT/INR), D-dimer, and fibrinogen tests.

I hope this helps.

Thank you.