Coronary artery lesions in pediatric scrub typhus: A case series from Guangzhou, China.

Abstract

Background: Scrub typhus, caused by Orientia tsutsugamushi, is a mite-borne rickettsial infection endemic to the Asia-Pacific region. While its systemic complications are well documented, coronary artery lesions (CALs) associated with scrub typhus in children remain poorly characterized. This study aimed to describe the clinical features, diagnostic challenges, and treatment outcomes of pediatric scrub typhus complicated by CALs.

Methodology/principal findings: We retrospectively analyzed seven pediatric patients (aged 11 months to 8 years) with scrub typhus and echocardiographically confirmed CALs, admitted to Guangzhou Women and Children's Medical Center, Guangzhou Medical University between 1January 2020 and 30 May 2026. Between 15 June 2025 and 1 July 2026, clinical data including epidemiological history, laboratory findings, imaging results, treatment regimens, and outcomes were collected from electronic medical records.

Conclusions/significance: Among the seven cases, CAL manifestations included coronary artery aneurysm (n = 2), coronary artery dilatation (n = 2), and coronary artery intimal thickening (n = 3). All seven patients were initially suspected of having Kawasaki disease.Six patients received intravenous immunoglobulin (IVIG), but all failed to respond. Among these six, four met the diagnostic criteria for Kawasaki disease (KD) or incomplete KD. Ultimately, all seven patients-including the one who did not receive IVIG-defervesced within 1-3 days of initiating antimicrobial therapy directed at scrub typhus.At follow-up, five patients with available echocardiography showed normalization of coronary arteries within one week to three months. These findings suggest that O. tsutsugamushi infection can trigger CALs indistinguishable from KD and that pathogen-directed therapy, rather than IVIG alone, is critical for fever resolution in such cases. Clinicians should maintain a high index of suspicion for scrub typhus in pediatric patients presenting with CALs, particularly when IVIG response is suboptimal.