(Kiosk 1) Bilateral Lower Extremity Weakness Secondary to Rickettsia Typhi Infection in a 26 Year-old Male: A Case Report

Case Diagnosis: A 26-year-old male with bilateral lower extremity weakness secondary to Murine typhus due to Rickettsia typhi.

Case Description or Program Description: The patient was admitted to an outside hospital for 2 weeks with high fever, excessive sweating, and generalized weakness. A lumbar puncture was performed and an MRI of the brain was negative for acute abnormalities. Extensive lab work revealed a diagnosis of Rickettsia typhi infection. After discharge, the patient began outpatient therapy and was prescribed tramadol 50 mg BID and pregabalin 75 mg BID. At outpatient evaluation 6 months after hospitalization, lumbar spine range of motion was intact with no tenderness to palpation. Strength was 3/5 for bilateral hip flexors, knee extensors, extensor hallucis longus, dorsiflexors, and 4/5 for bilateral plantar flexors. Lower extremity sensation was diminished with no apparent pattern bilaterally.

Setting: Outpatient general PMR clinic.

Assessment/Results: At 6 months post-infection, lower extremity weakness persisted. After several months of outpatient therapy, the patient progressed from a wheelchair to forearm crutches but is not back to his baseline activity. MRI cervical, thoracic, and lumbar spine revealed no abnormalities, making critical illness neuropathy/myopathy the most likely explanation for his lower extremity weakness. The patient is being referred to neurology for further evaluation and is to continue strengthening therapy.

Discussion (relevance): The literature review reveals an absence of peripheral neuropathic diagnoses secondary to Murine typhus infection, making this case unique. However, meningoencephalitis, behavioral and memory disturbances, and myositis have been diagnosed. Physicians should be aware of and consider this potential complication.

Conclusions: Rickettsia typhi, or Murine typhus, is a rare bacterial disease spread through infected fleas. Typical symptoms include fever, chills, body aches, and muscle pains. To our knowledge, this is the first reported case of debilitating bilateral lower extremity weakness secondary to this infection.