Severe Pneumonia as a Complication of Scrub Typhus: A Case Report From an Endemic Region

Scrub typhus, caused by Orientia tsutsugamushi, transmitted through bites from infected chiggers (larval mites), is a common infection in the Asia-Pacific region, including the Maldives, and typically presents with fever with myalgia, rash, eschar, and internal organ involvement. Pulmonary complications like severe pneumonia are less common but can be life-threatening. We report a case of a 51-year-old woman with underlying hypertension and rheumatoid arthritis on immunosuppressive therapy, who presented with high-grade fever, dry cough, and worsening shortness of breath. Physical examination revealed an eschar on her left thigh and crackles at both lung bases. Chest imaging showed bilateral ground-glass opacities consistent with interstitial pneumonia. Serological testing confirmed scrub typhus infection. She was treated with a combination therapy of doxycycline and azithromycin, along with supportive care in the ICU, resulting in full recovery. This case highlights the need to consider scrub typhus in patients with severe pneumonia from endemic areas, especially in those with underlying health conditions, to ensure timely diagnosis and treatment, which is critical for reducing complications of pneumonia and morbidity.