Spontaneous splenic rupture associated with scrub typhus: a case report

Background Scrub typhus,an acute febrile disease with mild to severe,life-threatening manifestations,potentially presents with a variety of complications,including pneumonia,acute respiratory distress syndrome,cardiac arrhyth-mias(such as atrial fibrillation),myocarditis,shock,peptic ulcer,gastrointestinal bleeding,meningitis,encephalitis,and renal failure.Of the various complications associated with scrub typhus,splenic rupture has rarely been reported,and its mechanisms are unknown.This study reports a case of scrub typhus-related spontaneous splenic rupture and identifies possible mechanisms through the gross and histopathologic findings.Case presentation A 78-year-old man presented to our emergency room with a 5-day history of fever and skin rash.On physical examination,eschar was observed on the left upper abdominal quadrant.The abdomen was not ten-der,and there was no history of trauma.The Orientia tsutsugamushi antibody titer using the indirect immunofluo-rescent antibody test was 1:640.On Day 6 of hospitalization,he complained of sudden-onset left upper abdominal quadrant pain and showed mental changes.His vital signs were a blood pressure of 70/40 mmHg,a heart rate pf 140 beats per min,and a respiratory rate of 20 breaths per min,with a temperature of 36.8℃.There were no signs of gastrointestinal bleeding,such as hematemesis,melena,or hematochezia.Grey Turner's sign was suspected during an abdominal examination.Portable ultrasonography showed retroperitoneal bleeding,so an emergency exploratory laparotomy was performed,leading to a diagnosis of hemoperitoneum due to splenic rupture and a sple-nectomy.The patient had been taking oral doxycycline(1o0 mg twice daily)for 6 days;after surgery,this was dis-continued,and intravenous azithromycin(500 mg daily)was administered.No arrhythmia associated with azithro-mycin was observed.However,renal failure with hemodialysis,persistent hyperbilirubinemia,and multiorgan failure occurred.The patient did not recover and died on the fifty-sixth day of hospitalization.Conclusions Clinicians should consider the possibility of splenic rupture in patients with scrub typhus who display sudden-onset abdominal pain and unstable vital signs.In addition,splenic capsular rupture and extra-capsular hem-orrhage are thought to be caused by splenomegaly and capsular distention resulting from red blood cell congestion in the red pulp destroying the splenic sinus.

Co-operative roles of IL-4Rαand IL-13Rα1 in the progression of ovarian carcinomas and the survival of ovarian carcinoma patients

Dear Editor,Recently,there has been a rise in interest in the roles of cytokines and cytokine receptors in malignant human tumors.Cytokine receptors,especially typeⅡinterleukin-4 receptor(IL-4R),have recently been examined as novel therapeutic targets of human cancers[1-3].The typeⅡIL-4R complex is composed of IL-4Rαand interleukin-13 receptorα1(IL-13Rα1),and the expression of IL-4Rαand IL-13Rα1 was higher in cancer tissues compared with normal counterpart tissues[3,4].