Scrub Typhus: Atypical Case Report of a Diagnostic Conundrum

Scrub typhus (ST) remains underdiagnosed despite a resurgence in incidence, because its frequently atypical clinical presentation can result in a low index of suspicion among clinicians. Here, we report the case of a middle-aged serviceman who presented at the emergency department of our hospital with diffuse, itchy rashes over his entire body, which had persisted for the prior 12 days, and high-grade fever, which was intermittent and associated with chills for the prior 10 days. The rash was widespread and diffuse all over his body, including the palms and soles, and was associated with red, watery eyes. Additional symptoms included difficulty and pain during deglutition; anorexia; and generalized weakness during the prior 6 days. Despite a systemic picture of lower respiratory tract infection with viral exanthema, the patient was serologically found to have ST according to his clinical presentation and radiological findings, thus posing a diagnostic dilemma. After serological confirmation, doxycycline therapy was initiated, and led to rapid and complete resolution of the atypical pneumonia, both clinically and radiographically. This case report highlights the importance of recognizing an uncommon clinical presentation of this atypical tropical disease, and achieving prompt diagnosis and treatment.