Cerebellitis as an atypical manifestation of scrub typhus.

A 21-year-old-man presented in a semiconscious state with 2 days’ inability to walk and 5 days’ history of fever (102.2°F) and rash. Examination revealed severe ataxia, slurred speech, and a scrotal scar (figure 1). Head CT and CSF studies were normal. Brain MRI revealed diffuse cerebellar cortical hyperintensity on T2 and fluidattenuated inversion recovery images (figure 2, A and B), with restriction (figure 2C) and postcontrast enhancement (figure 2D) suggesting inflammation. Weil-Felix test (OX-K-1:320) and immunoglobulin M ELISA were positive for scrub typhus. Improvement occurred after oral doxycycline. Isolated cerebellar involvement is rare in scrub typhus, a mite-born infection caused by Orentia tsutsugamushi that classically presents with fever, rash, and eschar. Laboratory confirmation is required to differentiate it from co–endemic diseases like typhoid, leptospirosis, and dengue.