Raj is a 45-year-old man who works as a software engineer in Bangalore. He has always been healthy, but over the past few weeks, he has been experiencing a range of strange symptoms that have left him feeling very worried.

Raj’s symptoms began with a persistent headache that seemed to be centered around his temples. He also started experiencing joint pain, particularly in his knees, and a feeling of general fatigue and malaise. Over the next few days, he developed a low-grade fever, which came and went, and a rash that appeared on his arms and legs.

Raj went to see his primary care physician, who conducted a thorough physical examination and ordered a battery of blood tests. The tests showed an elevated erythrocyte sedimentation rate (ESR) of 60 mm/hour (normal range is 0-20 mm/hour) and a C-reactive protein (CRP) level of 24 mg/L (normal range is less than 5 mg/L), suggesting an inflammatory process. The physician referred Raj to a rheumatologist for further investigation.

The rheumatologist conducted additional tests, including an X-ray of Raj’s knees and an MRI of his brain. Both tests came back normal, and the rheumatologist was also unable to provide a diagnosis. She referred Raj to an infectious disease specialist.

The infectious disease specialist took a detailed history and learned that Raj had recently visited a rural area in Maharashtra. Based on this information, the specialist conducted a battery of tests for infectious diseases that are endemic to rural India, including scrub typhus, leptospirosis, and malaria.

Finally, the test for scrub typhus came back positive. Scrub typhus is a bacterial infection that is transmitted by the bite of the larval stage of trombiculid mites, which are commonly found in rural areas of India.

Treatment for scrub typhus involves a course of antibiotics, such as doxycycline or azithromycin, which are often very effective when administered early in the course of the disease. In Raj’s case, the treatment was successful, and he began to feel much better within a few days. He was able to return to work and resume his normal activities, although he remained vigilant for any signs of a relapse.

Investigation Findings:

ESR: 60 mm/hour (normal range is 0-20 mm/hour)

CRP: 24 mg/L (normal range is less than 5 mg/L)

Positive test for scrub typhus

Medical Learning:

This  case highlights the importance of considering the possibility of infectious diseases in patients who present with fever and other nonspecific symptoms, especially if they have recently traveled to or live in rural areas where such diseases are endemic. It also illustrates the importance of conducting a thorough diagnostic workup, including blood tests and imaging studies, to rule out other potential causes of the symptoms.