Asian Journal of Medical Research and Case Reports

Background: Scrub typhus is an acute zoonotic infection caused by Orientia tsutsugamushi and may progress to thrombocytopenia and multiple organ dysfunction.

Case Presentation: A 57-year-old man presented with a one-week history of fever, cough with expectoration, headache, and dyspnoea. At admission, he was unconscious. Investigations showed severe thrombocytopenia, raised creatinine, hepatic dysfunction, encephalopathy, and acute kidney injury. Testing for scrub typhus was positive, while dengue and malaria markers were negative. During hospitalisation, the patient developed worsening respiratory status, decreased urine output, recurrent atrial fibrillation, septic shock, and multiple organ dysfunction. Bi-level positive airway pressure was initiated, followed by intubation and mechanical ventilation when respiratory status failed to improve. Doxycycline was added to the treatment regimen, with azithromycin and rifaximin also administered. Supportive management included intravenous antibiotics, fluids, inotropes, respiratory support, cardiovascular management, and continued monitoring. The patient subsequently improved, was extubated, and transferred from the intensive care unit to the ward. Platelet count increased, C-reactive protein decreased, acute kidney injury resolved, and liver function showed recovery. At discharge, the patient was clinically improved, haemodynamically stable, with improving sensorium and recovered renal and hepatic functions.

Conclusion: This case demonstrates the severe multisystem presentation of scrub typhus with thrombocytopenia and emphasises the importance of timely diagnosis, antimicrobial therapy, and supportive care.