Medical Science: Updates and Prospects Vol. 11

Background: Scrub typhus is a multisystem infection that may mimic surgical and infectious conditions, delaying recognition and treatment. Severe complications include acute respiratory distress syndrome, myocarditis, acute kidney injury, hepatic dysfunction, meningoencephalitis and rhabdomyolysis, particularly during the second week of untreated illness.

Case Presentation: We report a 14-year-old girl who presented with one week of abdominal pain, vomiting and loose stools, with marked epigastric and right hypochondrial guarding. Initial assessment considered common surgical causes; however, investigations demonstrated leucocytosis with thrombocytopenia, hyperbilirubinaemia, transaminitis, renal impairment and elevated D-dimer. Imaging showed gall bladder wall thickening, enlarged lymph nodes, caecal thickening and bilateral pulmonary opacities. Scrub typhus was suspected because of fever, thrombocytopenia and splenomegaly and was confirmed by positive immunoglobulin M serology.

Discussion: During admission, the patient developed shock requiring dopamine and noradrenaline, followed by progressive respiratory failure requiring invasive ventilation. Echocardiography showed left ventricular dysfunction with an ejection fraction of 40%. She also developed worsening acute kidney injury, metabolic acidosis, hyperkalaemia and disseminated intravascular coagulation requiring blood products. Despite antimicrobial escalation and intensive organ support, she developed sudden ventricular tachycardia and died after 24 hours of invasive ventilation.

Conclusion: This case highlights the need to consider scrub typhus in endemic settings when acute abdomen is accompanied by thrombocytopenia and early organ dysfunction.