Myoclonic jerks as a unique clinical manifestation in a patient with Murine Typhus (P5.137)

Objective: To report the first case of Rickettsia typhus infection manifesting with myoclonic jerking. Background: Murine typhus is a flea-borne infection caused by Rickettsia typhi through the inoculation of flea feces in bite wounds. It has been associated with sensory alternation, meningeal inflammation and CN VI and VII palsies. Moreover, myoclonic jerks has only been reported in scrub typhus, but not in murine typhus. Design/Methods: Retrospective review of a case of myoclonus jerks in a patient with murine typhus infection. Results: A 61-year-old male presented acutely with new onset fever, orofacial myoclonic jerking and altered sensorium. Prior to the admission, he had acutely developed headache, chills and intermittent dry cough after working in the lower parts of his house known to harbor opossums and rats. In hospital, patient was intubated due to concern for respiratory failure secondary to spontaneous persistent facial and proximal upper extremity myoclonic jerks. Blood work was negative, except for positive rickettsia antibody-IgG/IgM. Cerebrospinal fluid analysis demonstrated xanthochromia, white blood cell count of 31 with segmented cells 61% and lymphocytes 10%, glucose was 38 and protein was 75 with negative infectious workup. Electroencephalogram and brain MRI were unremarkable. After switching antibiotic to doxycycline, patient significantly improved clinically with resolution of myoclonus. Conclusions: Aseptic meningitis and meningo-encephalitis are known CNS manifestations of murine typhus. This case exemplifies the importance of expanding the secondary causes for myoclonus and aseptic meningitis to include murine typhus as a possible diagnosis in prevalent areas, and in the appropriate clinical context. Also, further imaging and electro-diagnostic tests may not be helpful in the diagnosis and maybe misleading. Appropriate recognition of sign and symptoms of CNS murine typhus can significantly improve the clinical outcome. Disclosure: Dr. Yusuf Solaiman has nothing to disclose. Dr. Hasan has nothing to disclose. Dr. Patel has nothing to disclose. Dr. Fang has nothing to disclose.