以反覆性發燒合併肝功能異常為表現之恙蟲病

Scrub Typhus Presenting with Recurrent Fever and Abnormal Liver Function

臨床上，發燒合併肝功能異常，常先入為主的認為是肝膽疾病或腹內感染症。本案例為55歲男性患者，因反覆發燒合併肝功能異常，診所以膽囊炎診斷處置，經口服抗生素治療未改善，故轉診至本院。透過病史詢問發現個案於發燒前有野外活動史，且理學檢查有淋巴結腫大及腋下皮膚焦痂病灶，經實驗室血清檢驗確定恙蟲病感染，以抗生素Doxycycline治療後，幸無後遺症發生、康復出院。因此，臨床面對發燒合併肝功能異常患者，除懷疑肝膽疾病外，應提高警覺詳細詢問職業、接觸史、群聚史及旅遊史，並確實執行身體評估，將恙蟲病列為鑑別診斷之一，避免延誤治療導致死亡。

In clinical practice, there is a general preconception that fever combined with abnormal liver function is caused by hepatobiliary disease or intraabdominal infection. Here, we report the case of a 55-year-old male patient who presented with recurrent fever and abnormal liver function, and hence was diagnosed with and treated for cholecystitis at the clinic. However, the patient did not improve after oral antibiotic treatment and was referred to our hospital. Taking the medical history revealed that the patient had engaged in outdoor activities prior to developing fever. Physical examination revealed swollen lymph nodes and an eschar on his armpit. Laboratory serological testing confirmed a diagnosis of scrub typhus infection. After treatment with the antibiotic, doxycycline, the patient recovered without sequelae and was discharged. Therefore, clinically, when treating patients who present with fever and abnormal liver function, clinicians should not only suspect hepatobiliary disease, but also take greater care to inquire about the patient’s occupation and contact, cluster, and travel histories. A physical examination should also be performed, and scrub typhus should be included as one of the options in differential diagnosis. This will prevent delays in treatment, which may lead to death.