Scrub typhus is a re-emerging and endemic disease in the Asia Pacific region caused by Orientia tsutsugamushi. We present a 65-year-old male from Sri Lanka who presented with fever, bilateral acute sensorineural hearing loss, and confusion. On examination, he was dehydrated. Significant orthostatic hypotension and an eschar were noted. Investigations revealed hyponatremia with elevated urine sodium, reduced serum osmolality, and normal urine osmolality suggestive of cerebral salt wasting. After initial hydration with 0.9% NaCl, hyponatremia was corrected with 3% NaCl. Oral doxycycline was prescribed, and he showed dramatic clinical improvement. A diagnosis of typhus must be considered in a patient presenting with a febrile illness and acute hearing loss. Cerebral salt-wasting disease should be considered in a patient with typhus who develops hyponatremia with dehydration. Furthermore, acute sensorineural hearing loss in both ears is an important manifestation of the disease.

中文翻译：

---

恙虫病伴双侧急性感音神经性听力损失和脑性盐耗病的病例报告。

恙虫病是亚太地区重新出现的地方性疾病，由恙虫病东方体引起。我们介绍了一名来自斯里兰卡的 65 岁男性，他出现发烧、双侧急性感音神经性听力损失和精神错乱。经检查，他处于脱水状态。注意到明显的直立性低血压和焦痂。研究显示低钠血症伴有尿钠升高、血清渗透压降低，而尿渗透压正常则提示存在脑盐消耗。用 0.9% NaCl 进行初步水化后，用 3% NaCl 纠正低钠血症。医生给他开了口服多西环素，他的临床症状得到了显着改善。对于出现发热性疾病和急性听力损失的患者，必须考虑斑疹伤寒的诊断。斑疹伤寒患者出现低钠血症并伴有脱水时，应考虑脑性盐消耗性疾病。此外，双耳急性感音神经性听力损失是该病的重要表现。