You are correct. Tsutsugamushi dz is a rickettsial infxn caused by Orientia tsutsugamushi. The microorganism is introduced via the bite of a larval-stage trombiculid mite. It occurs in people who visit mite-infected habitats such as brush and grass in endemic areas in Asia. An eschar is seen in 23 to 78% of cases. It begins as a small papule that enlarges, undergoes central necrosis, and eventually acquires a blackened crust w/ an erythematous halo that resembles a cigarette burn. Geographical context and travel hx provide clues to the dx. However, detailed and repeated examination—to identify the eschar—is the cornerstone of dx of tsutsugamushi dz. Tetracycline and doxycycline are highly effective treatments. The pt was treated w/ oral minocycline and recovered fully.

You are correct. Upon f/u 4 wks later, cement deposits could be seen moving outwards onto the external auditory canal. The cement migrated out along w/ the natural migration of the tympanic membrane epithelium. This case supports an ENT-led conservative approach to adherent foreign bodies, relying on natural migration rather than risking damage to the tympanic membrane as a result of surgical removal. The pt’s hearing continued to improve as migration occurred.