Corneal injury associated with scrub typhus following mite exposure in a child in Taiwan: a case report

BACKGROUND: Scrub typhus is a mite-borne zoonosis endemic to the Asia-Pacific region. Although ocular complications are occasionally reported during later stages of infection, direct mechanical ocular injury related to mite exposure has rarely been reported. Recognition of early ocular manifestations may facilitate timely diagnosis and treatment of this potentially serious infection. CASE PRESENTATION: We describe a rare case of a 9-year-old Taiwanese boy who developed acute ocular and systemic symptoms after exposure to mites during a visit to Alishan Forest, Taiwan. Live mites were identified attached to the lower eyelid margins and ocular surface. The left eye showed multiple linear corneal epithelial abrasions with stromal edema, causing severe photophobia, tearing, and reduced visual acuity. The following day, the patient developed fever, headache, myalgia, and a necrotic eschar at the bite site, clinically suggestive of scrub typhus. The diagnosis was primarily based on clinical presentation and endemic exposure history because confirmatory serologic or PCR testing was not performed. Early administration of topical antibiotics, corticosteroids, and systemic doxycycline led to complete resolution of both ocular and systemic symptoms within 10 days without residual deficits. CONCLUSIONS: To our knowledge, few reports have described concurrent corneal injury and clinically suspected scrub typhus following direct mite exposure at the initial stage of contact. This case highlights the importance of considering mite-related ocular injury and scrub typhus in the differential diagnosis of acute ocular trauma and febrile illness following outdoor activities in endemic areas. Early recognition and prompt initiation of appropriate therapy may help prevent complications and improve clinical outcomes.