A case of Scrub Typhus presenting with high fever, eschar, septic shock, ARDS, acute kidney injury, thrombocytopenia, hypoalbuminemia and transaminitis in 50-year-old man coming back from Delta region of Myanmar

Abstract

A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and acute kidney injury following 8 days history of high fever. Eschar was noted on right forearm. His temperature was 105°F; very ill and toxic with SaO2 90% on air. He was hypotensive (80/50 mmHg), tachycardic (128/ min), tachypneic (respiratory rate 32/min) with low SaO2 (90% on air); crackles were audible in both lungs. Chest radiograph showed patchy opacities in both lungs. He had low Platelet count (34 x 109/mm3), raised serum creatinine (160 μmol/L), raised liver enzymes (SGOT 121 U/L & SGPT 86 U/L) and low serum albumin (22 mg%). Rapid test for Scrub Typhus IgM was positive. The patient recovered with oxygen therapy, fluid replacement, inotropes, cefopyrazone/salbactam and doxycycline.