MURINE TYPHUS PRESENTING AS ACUTE CHOLECYSTITIS

Murine Typhus, once thought to have been eradicated throughout the United States, is on the rise in Texas. Humans are accidental hosts that get infected through a flea bite. The disease is often self-limited and presents with non-specific symptoms such as fever, chills, malaise, headache and rash. Here we present a case of a healthy hispanic female with acute cholecystitis and underlying murine typhus. Patient is a 57 year old hispanic female with no past medical history that presented with emesis, headache, fever, chills and myalgias. Llabs showed thrombocytopenia and elevated LFTs. Abdominal ultrasound showed evidence of cholelithiasis. Patient had a cholecystectomy after which she developed persistent fever and hypotension. Patient was started on antibiotics. The following day, she developed a faint red maculopapular rash over her trunk and extremities. The fever persisted for the next 48 hours. Due to her initial thrombocytopenia and new rash, the patient was started on IV doxycycline. Rickettsia titers were elevated confirming a rickettsial infection. Murine typhus is a vector borne zoonosis typically seen in tropical countries. Symptoms are vague and often self limited. Patient history included travel to south Texas with exposure to farm animals but with no recollection of a tick bite. Her initial symptoms of nausea and vomiting led to diagnosis of cholecystitis. Treatment of choice continues to be Doxycycline for at least for 7 days. With the number of cases increasing in Texas it is important that health care providers recognize the vague symptoms of murine typhus.