Key result
Doxycycline resolves scrub typhus presenting with atypical cellulitis, hyperbilirubinemia, and AKI.
Case Report (n=1)
Scrub typhus should be considered in the differential diagnosis for travelers presenting with cellulitis and systemic symptoms to ensure timely treatment.
Scrub typhus merits consideration in travelers with cellulitis-like illness plus hyperbilirubinemia or AKI; single case leaves diagnostic algorithms open.
Cellulitis is a common bacterial skin infection characterized by erythema, swelling, and pain of the affected skin and subcutaneous tissues. The lower limbs are a commonly affected area due to microtrauma and gravity-dependent stagnation of blood. We describe a case of a male patient with an extensive travel history who presented with left lower limb cellulitis, hyperbilirubinemia, and acute kidney injury. When workup for the usual causes of cellulitis did not provide a clearer picture, we had to consider the unusual. Considering his travel history, an exotic tropical zoonotic disease was considered, and an eschar was searched for. Upon further investigation, he tested positive for the Weil-Felix test and responded very well to doxycycline. Our case emphasizes the need to suspect scrub typhus in travelers, even with unusual presentations, for timely diagnosis and treatment to prevent the development of various complications and ensure earlier recovery of patients. It usually presents as an acute febrile illness, but the diagnosis is often missed due to similarities with other tropical febrile infections.
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A 2025 study conducted a case report in Scrub typhus (n=1). Doxycycline was evaluated on Clinical response. A male traveler presenting with atypical cellulitis, hyperbilirubinemia, and acute kidney injury was diagnosed with scrub typhus and responded well to doxycycline.
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