Scrub Typhus–Associated Guillain–Barré Syndrome with Bilateral Facial Palsy: A Case Report and Literature Review

Abstract

Scrub typhus is an endemic zoonotic infection within the Tsutsugamushi Triangle and is an important cause of acute febrile illness with variable systemic and neurological manifestations. Guillain-Barré syndrome (GBS) is an uncommon peripheral nervous system complication, and bilateral facial diplegia as a presenting feature is rare. This case report describes a 50-year-old previously healthy woman who developed rapidly progressive ascending limb weakness, dysarthria, dysphagia, and bilateral lower motor neuron facial palsy after a short febrile illness. On admission, she was afebrile and conscious, with marked limb weakness and reduced lower-limb reflexes. Serological testing showed positive IgM antibodies against Orientia tsutsugamushi by ELISA. Cerebrospinal fluid analysis demonstrated albuminocytological dissociation with elevated protein and few cells, while nerve conduction studies were consistent with acute inflammatory demyelinating sensorimotor polyneuropathy. Other evaluated infectious and autoimmune causes were negative. The patient received intravenous immunoglobulin for five days and intravenous doxycycline for seven days. Neurological recovery was progressive, with improvement in limb strength, cranial nerve function, and GBS Disability Score from 4 at presentation to 2 at discharge and 1 at the 3-month follow-up. This report highlights the need to consider scrub typhus as a possible antecedent infection in GBS, particularly in endemic regions when bilateral facial palsy follows a febrile illness.