Eun Lee and Nae-Yun Heo
Background: Systemic rash combined with prolonged fever requires a differential diagnosis of possible diseases including infectious diseases. Although scrub typhus can cause co-infection with leptospirosis, co-infection with Orientia tsutsugamushi and Mycoplasma pneumoniae is thought to be rare, with only one case reported in a young adult. However, to date, there have been no reports of simultaneous co-infection with three pathogens, including Orientia tsutsugamushi, hepatitis B, and Mycoplasma pneumoniae.
Case: We report a child simultaneously co-infected with Orientia tsutsugamushi, acute hepatitis B, and Mycoplasma pneumoniae, which made her prolonged fever and systemic rash with mild itching. On day 2 of hospitalization, an eschar on the left inguinal area became prominent and antibodies against Orientia tsutsugamushi showed levels = 1:1520. Owing to an elevation in the levels of liver enzymes at admission, IgM for hepatitis B surface antigen was positive and IgG for hepatitis B surface antigen was negative. Following two days of tetracycline administration, the fever subsided and the systemic area skin rashes gradually improved.
Conclusion: Proper evaluation based on the presenting symptoms during the illness is important to ensure that the differential diagnosis is not overlooked.
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