Scrub Typhus Induced Sepsis – A Rare Cause of Takotsubo Cardiomyopathy

Scrub Typhus Induced Sepsis – A Rare Cause of Takotsubo Cardiomyopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Scrub Typhus Induced Sepsis – A Rare Cause of Takotsubo Cardiomyopathy Shikha Sood, Deepak Kumar, Kushagra Sharma, Kishitaa Rohilla This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7393368/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Takotsubo cardiomyopathy is a reversible left ventricular dysfunction, usually triggered by emotional or physical stress. Infectious causes are uncommon. We report a rare case of scrub typhus–induced Takotsubo cardiomyopathy, highlighting infection as a potential trigger. Case Presentation: A 62-year-old woman presented with fever, vomiting, and epigastric pain. She was hypotensive and tachycardic. Electrocardiography showed Q waves in V1–V3, and NT-proBNP was elevated. Serology confirmed scrub typhus. Echocardiography revealed reduced ejection fraction with apical hypokinesia. Cardiac MRI demonstrated apical ballooning and myocardial oedema without late gadolinium enhancement, consistent with Takotsubo cardiomyopathy and excluding infarction or myocarditis. She was treated with antibiotics, inotropes, and supportive therapy, with subsequent recovery. Conclusion: Scrub typhus can precipitate Takotsubo cardiomyopathy, a rare but reversible cause of acute cardiac dysfunction. Cardiac MRI is essential for diagnosis and exclusion of mimics. Early recognition and timely management improve outcomes. Scrub Typhus Takotsubo Cardiomyopathy Sepsis Cardiac Magnetic Resonance Imaging Figures Figure 1 Figure 2 Figure 3 1 BACKGROUND Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, was first described in 1990 by Sato et al. It is characterized by acute, reversible left ventricular dysfunction, often with apical ballooning resembling a “takotsubo” pot. Unlike acute myocardial infarction, TTC occurs in the absence of obstructive coronary artery disease, although the clinical presentation may mimic infarction. The condition primarily affects postmenopausal women and is commonly triggered by emotional stress, physical illness, or acute neurological events. Infectious triggers have rarely been documented, with only limited reports describing sepsis-induced TTC. This case demonstrates a rare presentation of TTC secondary to scrub typhus infection, expanding the spectrum of precipitating factors and emphasizing the need for heightened awareness in endemic regions. 2 Case report A 62-year-old woman presented to the emergency department with a 7-day history of fever, vomiting, and epigastric pain. On examination, she was tachycardic and hypotensive, with mild epigastric tenderness. Electrocardiography revealed Q waves in the precordial leads (V1–V3). Laboratory investigations showed elevated NT-proBNP levels (1810 pg/ml), consistent with heart failure. Serology confirmed scrub typhus infection. Transthoracic echocardiography demonstrated mild left ventricular enlargement with an ejection fraction of 30% and apical hypokinesia, with preserved basal contractility. A minimal pericardial effusion was also noted. These findings raised suspicion of takotsubo cardiomyopathy (TTC). Cardiac magnetic resonance imaging (CMR) confirmed the diagnosis, showing left ventricular end-diastolic dimension of 4.6 cm, mid-to-apical hypokinesia with apical ballooning (Fig. 1), and myocardial oedema on T2-weighted imaging (Fig. 2). Importantly, no late gadolinium enhancement was observed (Fig. 3), effectively excluding ischemic or fibrotic aetiologies. The patient was managed for scrub typhus–induced sepsis and heart failure with inotropic support, targeted antibiotics, and standard supportive therapy. She showed clinical and hemodynamic improvement, with gradual recovery of cardiac function. 3 Disscussion Takotsubo cardiomyopathy (TTC), or stress-induced cardiomyopathy, is a transient, reversible non-ischemic cardiomyopathy characterized by acute left ventricular dysfunction. First described by Sato et al. In 1990 [ 1 ], it typically mimics acute myocardial infarction (mi), presenting with chest pain, ECG changes, and elevated cardiac biomarkers, but without obstructive coronary artery disease. Imaging is key for distinguishing TTC from MI or myocarditis. The exact pathophysiology remains incompletely understood. The leading hypothesis involves catecholamine-mediated myocardial stunning, supported by markedly elevated catecholamine levels in affected patients [ 2 ]. Regional vulnerability is thought to relate to the higher density of β-adrenergic receptors in apical segments, explaining the characteristic apical ballooning. Additional mechanisms include microvascular dysfunction, coronary vasospasm, and oxidative stress [ 3 ]. Postmenopausal oestrogen deficiency may further increase susceptibility through impaired endothelial function and enhanced sympathetic activation [ 4 ]. Our case is notable for TTC triggered by scrub typhus, a rickettsial infection that can cause sepsis, systemic inflammation, and cardiovascular stress. While TTC is usually associated with emotional or physical stress, infectious triggers, including influenza and viral myocarditis, have been reported [ 4 ]. Sepsis-induced catecholamine surge likely contributed to TTC in this patient, highlighting the need to consider infectious aetiologies in endemic regions. Cardiac magnetic resonance (CMR) was critical in establishing the diagnosis, revealing apical ballooning, mid-to-apical hypokinesia, and myocardial oedema, with no late gadolinium enhancement. This pattern differentiates TTC from mi, myocarditis, and other cardiomyopathies. Advanced CMR techniques—such as feature-tracking strain analysis, T1/T2 mapping, and extracellular volume quantification—enhance detection of subtle myocardial injury and inflammation and may provide prognostic insights [ 2 , 5 ]. Management of TTC is primarily supportive, including hemodynamic stabilization, treatment of precipitating factors, and standard heart failure therapy as indicated. Most patients experience complete recovery of ventricular function within weeks, though complications such as arrhythmias, heart failure, and thromboembolism can occur. In our patient, targeted antibiotic therapy for scrub typhus and supportive care led to gradual recovery, demonstrating the importance of early recognition and tailored management. 4 CONCLUSION Takotsubo cardiomyopathy is a rare, reversible cause of acute left ventricular dysfunction triggered by various stressors, including infections like scrub typhus. Cardiac MRI is essential for diagnosis and differentiation from other myocardial injuries. This case highlights the need to consider TTC in patients with chest pain, heart failure, and elevated cardiac biomarkers, particularly when coronary artery disease is absent. Abbreviations • TTC Takotsubo Cardiomyopathy • NT-proBNP N-terminal pro-B-type Natriuretic Peptide • ECG Electrocardiography • CMR Cardiac Magnetic Resonance • MRI Magnetic Resonance Imaging Declarations Ethics approval and consent to participate: Institutional Review Board approval is not required. Consent for publication: Written informed consent was obtained from the patient for publication of this case. report. Competing interests: Not applicable. Funding: Not applicable. Author Contribution 1. Concepts, Design, Definition of intellectual content, Literature search, Manuscript preparation, Manuscript editing and review.2. Literature search, Manuscript preparation, Manuscript editing and review.3. Manuscript preparation, Manuscript editing and review.4. Manuscript preparation, Manuscript editing and review. Acknowledgements: Not applicable. Availability of data and material: All data and materials available with the authors. References Sato H, Tateishi H, Uchida T, et al. Takotsubo type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze K, Hon M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagaku Hyoronsha; 1990. p. 56–64. [in Japanese] Ojha V, Khurana R, Ganga KP, Kumar S. Advanced cardiac magnetic resonance imaging in takotsubo cardiomyopathy. Br J Radiol. 2020;93(1115):20200514. doi: 10.1259/bjr.20200514 Fernández-Pérez GC, Aguilar-Arjona JA, de la Fuente GT, Samartín M, Ghioldi A, Arias JC, Sánchez-González J. Takotsubo cardiomyopathy: assessment with cardiac MRI. AJR Am J Roentgenol. 2010;195(2): W139–45. doi: 10.2214/AJR.09.3369 Roshanzamir S, Showkathali R. Takotsubo cardiomyopathy: a short review. Curr Cardiol Rev. 2013;9(3):191–6. doi: 10.2174/1573403x11309030003 Zghyer F, Botheju WSP, Kiss JE, Michos ED, Corretti MC, Mukherjee M, Hays AG. Cardiovascular imaging in stress cardiomyopathy (Takotsubo syndrome). Front Cardiovasc Med. 2022; 8:799031. doi: 10.3389/fcvm.2021.799031 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7393368","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":504452138,"identity":"d7ec107c-69e6-41cd-b07d-7ed3ff1f382a","order_by":0,"name":"Shikha Sood","email":"","orcid":"","institution":"IGMC","correspondingAuthor":false,"prefix":"","firstName":"Shikha","middleName":"","lastName":"Sood","suffix":""},{"id":504452139,"identity":"01cc0c02-8d59-41dc-91c6-6b883a21200d","order_by":1,"name":"Deepak Kumar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDCCA2AiAUQyM3wAkmzspGhhnAHSwkyKFmYeiGX4Ad/x5mMPfpxJyzc43vvY2ObXNnk+ZgbGDx9zcGuRPHMs3bDnRo7lhjPHjZNz+24btjEzMEvO3IZbi8GNHDMJng8VBmY30pgP5/bcZgRqYWPmxafl/vtvkn9gWix7btsT1nKDh02a50YOWEsyw4/biQS1SJ5JMzeWOZNmYH/mGLNhb8Pt5DZmxma8fuE7fvjZwzfHkg0k29uYJX78uW07v7354IePeLQAARuCydgGJhvwqkfVwvCHkOJRMApGwSgYiQAAyDVWAaKn3VYAAAAASUVORK5CYII=","orcid":"","institution":"IGMC","correspondingAuthor":true,"prefix":"","firstName":"Deepak","middleName":"","lastName":"Kumar","suffix":""},{"id":504452140,"identity":"cb755c24-8a8b-4681-b654-7efe657bbdff","order_by":2,"name":"Kushagra Sharma","email":"","orcid":"","institution":"MBBS, MMU","correspondingAuthor":false,"prefix":"","firstName":"Kushagra","middleName":"","lastName":"Sharma","suffix":""},{"id":504452141,"identity":"152ff8f3-825d-424a-ba67-542fd3d3d7d7","order_by":3,"name":"Kishitaa Rohilla","email":"","orcid":"","institution":"MBBS, MMU","correspondingAuthor":false,"prefix":"","firstName":"Kishitaa","middleName":"","lastName":"Rohilla","suffix":""}],"badges":[],"createdAt":"2025-08-17 15:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7393368/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7393368/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90309680,"identity":"283d5bbb-7f6c-46f0-a5bb-3bdc6f1d6904","added_by":"auto","created_at":"2025-09-01 09:40:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":301474,"visible":true,"origin":"","legend":"\u003cp\u003eCine cardiac magnetic resonance (CMR) still frame demonstrating mid-to-apical hypokinesia with classical apical ballooning, characteristic of Takotsubo cardiomyopathy.\u003c/p\u003e","description":"","filename":"FIGURE1.png","url":"https://assets-eu.researchsquare.com/files/rs-7393368/v1/28312b7cf38a85d4c40f44b9.png"},{"id":90309684,"identity":"9d41e554-8fca-4562-b0c3-466828dac8f7","added_by":"auto","created_at":"2025-09-01 09:40:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":688359,"visible":true,"origin":"","legend":"\u003cp\u003eT2-weighted cardiac magnetic resonance image showing myocardial hyperintensity in the apical segments, consistent with myocardial oedema.\u003c/p\u003e","description":"","filename":"FIGURE2.png","url":"https://assets-eu.researchsquare.com/files/rs-7393368/v1/065cc2b5a38690ed8a6a622b.png"},{"id":90311130,"identity":"d122266c-e9e6-4248-ab1a-deeb7c4ce308","added_by":"auto","created_at":"2025-09-01 09:48:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":777417,"visible":true,"origin":"","legend":"\u003cp\u003eLate gadolinium enhancement sequence demonstrating absence of enhancement, excluding ischemic or fibrotic myocardial injury.\u003c/p\u003e","description":"","filename":"FIGURE3.png","url":"https://assets-eu.researchsquare.com/files/rs-7393368/v1/3c58174cf23c24f9ee945172.png"},{"id":90312809,"identity":"6f4663a2-d5d7-47d5-bb3e-0613683aa0b4","added_by":"auto","created_at":"2025-09-01 10:04:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1866024,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7393368/v1/9d2e9d84-2d35-49c2-b2fe-af72343bed76.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Scrub Typhus Induced Sepsis – A Rare Cause of Takotsubo Cardiomyopathy","fulltext":[{"header":"1 BACKGROUND","content":"\u003cp\u003eTakotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, was first described in 1990 by Sato et al. It is characterized by acute, reversible left ventricular dysfunction, often with apical ballooning resembling a \u0026ldquo;takotsubo\u0026rdquo; pot. Unlike acute myocardial infarction, TTC occurs in the absence of obstructive coronary artery disease, although the clinical presentation may mimic infarction. The condition primarily affects postmenopausal women and is commonly triggered by emotional stress, physical illness, or acute neurological events.\u003c/p\u003e\u003cp\u003eInfectious triggers have rarely been documented, with only limited reports describing sepsis-induced TTC. This case demonstrates a rare presentation of TTC secondary to scrub typhus infection, expanding the spectrum of precipitating factors and emphasizing the need for heightened awareness in endemic regions.\u003c/p\u003e"},{"header":"2 Case report","content":"\u003cp\u003eA 62-year-old woman presented to the emergency department with a 7-day history of fever, vomiting, and epigastric pain. On examination, she was tachycardic and hypotensive, with mild epigastric tenderness. Electrocardiography revealed Q waves in the precordial leads (V1\u0026ndash;V3). Laboratory investigations showed elevated NT-proBNP levels (1810 pg/ml), consistent with heart failure. Serology confirmed scrub typhus infection.\u003c/p\u003e\u003cp\u003eTransthoracic echocardiography demonstrated mild left ventricular enlargement with an ejection fraction of 30% and apical hypokinesia, with preserved basal contractility. A minimal pericardial effusion was also noted. These findings raised suspicion of takotsubo cardiomyopathy (TTC). Cardiac magnetic resonance imaging (CMR) confirmed the diagnosis, showing left ventricular end-diastolic dimension of 4.6 cm, mid-to-apical hypokinesia with apical ballooning (Fig.\u0026nbsp;1), and myocardial oedema on T2-weighted imaging (Fig.\u0026nbsp;2). Importantly, no late gadolinium enhancement was observed (Fig.\u0026nbsp;3), effectively excluding ischemic or fibrotic aetiologies.\u003c/p\u003e\u003cp\u003eThe patient was managed for scrub typhus\u0026ndash;induced sepsis and heart failure with inotropic support, targeted antibiotics, and standard supportive therapy. She showed clinical and hemodynamic improvement, with gradual recovery of cardiac function.\u003c/p\u003e"},{"header":"3 Disscussion","content":"\u003cp\u003eTakotsubo cardiomyopathy (TTC), or stress-induced cardiomyopathy, is a transient, reversible non-ischemic cardiomyopathy characterized by acute left ventricular dysfunction. First described by Sato et al. In 1990 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it typically mimics acute myocardial infarction (mi), presenting with chest pain, ECG changes, and elevated cardiac biomarkers, but without obstructive coronary artery disease. Imaging is key for distinguishing TTC from MI or myocarditis.\u003c/p\u003e\u003cp\u003eThe exact pathophysiology remains incompletely understood. The leading hypothesis involves catecholamine-mediated myocardial stunning, supported by markedly elevated catecholamine levels in affected patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Regional vulnerability is thought to relate to the higher density of β-adrenergic receptors in apical segments, explaining the characteristic apical ballooning. Additional mechanisms include microvascular dysfunction, coronary vasospasm, and oxidative stress [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Postmenopausal oestrogen deficiency may further increase susceptibility through impaired endothelial function and enhanced sympathetic activation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur case is notable for TTC triggered by scrub typhus, a rickettsial infection that can cause sepsis, systemic inflammation, and cardiovascular stress. While TTC is usually associated with emotional or physical stress, infectious triggers, including influenza and viral myocarditis, have been reported [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Sepsis-induced catecholamine surge likely contributed to TTC in this patient, highlighting the need to consider infectious aetiologies in endemic regions.\u003c/p\u003e\u003cp\u003eCardiac magnetic resonance (CMR) was critical in establishing the diagnosis, revealing apical ballooning, mid-to-apical hypokinesia, and myocardial oedema, with no late gadolinium enhancement. This pattern differentiates TTC from mi, myocarditis, and other cardiomyopathies. Advanced CMR techniques\u0026mdash;such as feature-tracking strain analysis, T1/T2 mapping, and extracellular volume quantification\u0026mdash;enhance detection of subtle myocardial injury and inflammation and may provide prognostic insights [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eManagement of TTC is primarily supportive, including hemodynamic stabilization, treatment of precipitating factors, and standard heart failure therapy as indicated. Most patients experience complete recovery of ventricular function within weeks, though complications such as arrhythmias, heart failure, and thromboembolism can occur. In our patient, targeted antibiotic therapy for scrub typhus and supportive care led to gradual recovery, demonstrating the importance of early recognition and tailored management.\u003c/p\u003e"},{"header":"4 CONCLUSION","content":"\u003cp\u003eTakotsubo cardiomyopathy is a rare, reversible cause of acute left ventricular dysfunction triggered by various stressors, including infections like scrub typhus. Cardiac MRI is essential for diagnosis and differentiation from other myocardial injuries. This case highlights the need to consider TTC in patients with chest pain, heart failure, and elevated cardiac biomarkers, particularly when coronary artery disease is absent.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; TTC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTakotsubo Cardiomyopathy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; NT-proBNP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eN-terminal pro-B-type Natriuretic Peptide\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; ECG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eElectrocardiography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; CMR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCardiac Magnetic Resonance\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; MRI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003eInstitutional Review Board approval is not required.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003e Written informed consent was obtained from the patient for publication of this case. report.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interests:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e1. Concepts, Design, Definition of intellectual content, Literature search, Manuscript preparation, Manuscript editing and review.2. Literature search, Manuscript preparation, Manuscript editing and review.3. Manuscript preparation, Manuscript editing and review.4. Manuscript preparation, Manuscript editing and review.\u003c/p\u003e\u003ch2\u003eAcknowledgements:\u003c/h2\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eAvailability of data and material:\u003c/h2\u003e\u003cp\u003eAll data and materials available with the authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSato H, Tateishi H, Uchida T, et al. Takotsubo type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze K, Hon M, editors. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagaku Hyoronsha; 1990. p. 56\u0026ndash;64. [in Japanese]\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOjha V, Khurana R, Ganga KP, Kumar S. Advanced cardiac magnetic resonance imaging in takotsubo cardiomyopathy. Br J Radiol. 2020;93(1115):20200514. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1259/bjr.20200514\u003c/span\u003e\u003cspan address=\"10.1259/bjr.20200514\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-P\u0026eacute;rez GC, Aguilar-Arjona JA, de la Fuente GT, Samart\u0026iacute;n M, Ghioldi A, Arias JC, S\u0026aacute;nchez-Gonz\u0026aacute;lez J. Takotsubo cardiomyopathy: assessment with cardiac MRI. AJR Am J Roentgenol. 2010;195(2): W139\u0026ndash;45. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2214/AJR.09.3369\u003c/span\u003e\u003cspan address=\"10.2214/AJR.09.3369\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoshanzamir S, Showkathali R. Takotsubo cardiomyopathy: a short review. Curr Cardiol Rev. 2013;9(3):191\u0026ndash;6. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2174/1573403x11309030003\u003c/span\u003e\u003cspan address=\"10.2174/1573403x11309030003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZghyer F, Botheju WSP, Kiss JE, Michos ED, Corretti MC, Mukherjee M, Hays AG. Cardiovascular imaging in stress cardiomyopathy (Takotsubo syndrome). Front Cardiovasc Med. 2022; 8:799031. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fcvm.2021.799031\u003c/span\u003e\u003cspan address=\"10.3389/fcvm.2021.799031\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Scrub Typhus, Takotsubo Cardiomyopathy, Sepsis, Cardiac Magnetic Resonance Imaging","lastPublishedDoi":"10.21203/rs.3.rs-7393368/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7393368/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTakotsubo cardiomyopathy is a reversible left ventricular dysfunction, usually triggered by emotional or physical stress. Infectious causes are uncommon. We report a rare case of scrub typhus\u0026ndash;induced Takotsubo cardiomyopathy, highlighting infection as a potential trigger.\u003c/p\u003e\u003cp\u003e\u003cb\u003eCase Presentation:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA 62-year-old woman presented with fever, vomiting, and epigastric pain. She was hypotensive and tachycardic. Electrocardiography showed Q waves in V1\u0026ndash;V3, and NT-proBNP was elevated. Serology confirmed scrub typhus. Echocardiography revealed reduced ejection fraction with apical hypokinesia. Cardiac MRI demonstrated apical ballooning and myocardial oedema without late gadolinium enhancement, consistent with Takotsubo cardiomyopathy and excluding infarction or myocarditis. She was treated with antibiotics, inotropes, and supportive therapy, with subsequent recovery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eScrub typhus can precipitate Takotsubo cardiomyopathy, a rare but reversible cause of acute cardiac dysfunction. Cardiac MRI is essential for diagnosis and exclusion of mimics. Early recognition and timely management improve outcomes.\u003c/p\u003e","manuscriptTitle":"Scrub Typhus Induced Sepsis – A Rare Cause of Takotsubo Cardiomyopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-01 09:40:28","doi":"10.21203/rs.3.rs-7393368/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93f1badb-6fa2-4047-83f3-2929c32d825d","owner":[],"postedDate":"September 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-15T10:53:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-01 09:40:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7393368","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7393368","identity":"rs-7393368","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}