Scrub Typhus Presenting with Isolated Xerostomia

Scrub typhus is a mite-borne rickettsial infection that typically presents with fever, rash, and eschar; however, atypical manifestations may lead to delayed or missed diagnosis. The present report involves a case of a 65-year-old woman who presented with persistent xerostomia (dry mouth) as the sole ongoing symptom at the time of evaluation, without rash, eschar, or ongoing fever. She had a history of outdoor exposure in an endemic area, and laboratory testing revealed transient liver dysfunction and hyponatremia associated with polydipsia. Although empiric antimicrobial therapy was not initiated because of spontaneous clinical improvement, paired serological testing revealed a more than 8-fold rise in antibody titers against Orientia tsutsugamushi, confirming the diagnosis of scrub typhus. A review of recent cases without classical findings highlights frequent diagnostic delay and heterogeneous clinical outcomes. The present case underscores the limitations of relying on classical clinical hallmarks and emphasizes the importance of epidemiological context and clinical reasoning when evaluating atypical presentations of scrub typhus in endemic regions.