CSF analysis revealed no cells, mildly raised proteins (75 mg/dl), and normal glucose. CSF Grams staining, culture, India Ink preparation, and GeneXpert for Tuberculosis, was negative. Blood cultures were sterile. Scrub typhus IgM antibodies were detected using Enzyme-Linked-Immunosorbent-Assay (ELISA). Abdominal ultrasound revealed hepatomegaly.
MRI-Brain revealed diffuse gyral swelling and hyperintensity on T2-weighted and FLAIR sequences involving bilateral lobes with no diffusion restriction, consistent with encephalitis. No abnormal post-contrast enhancement was noted. MRI-Spine was normal. Nerve Conduction Studies (NCS) were suggestive Acute Motor Axonal Neuropathy (AMAN) variant of Guillain-Barré-Syndrome (GBS).
The patient received doxycycline. IVIG was added after NCS results. His condition gradually improved, and there was regaining of muscle strength in the following weeks with physiotherapy.