A case of Scrub Typhus presenting with high fever, eschar, septic shock, ARDS, acute kidney injury, thrombocytopenia, hypoalbuminemia and transaminitis in 50-year-old man coming back from Delta region of Myanmar
Authors:   Professor and Head/Senior Consultant Physician, Department of Medicine/ Department of Nephrology, Defence Services Medical Academy/ No. (1) Defence Services General Hospital (1000-Bedded)., Pyar Khin Phyu , Hla Sai Aik ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Hlaing Soe Win ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Aung Zar Ni Htet ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Maung Nyan Lin ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Kyaw Aung Phyoe ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Aung Soe Min ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Lin Thein Nay ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Htet Swan ,   Consultant Microbiologist, No. (1) Defence Services General Hospital (1000-Bedded)., Ya Kyaw Zay ,   Consultant Hematologist, No. (1) Defence Services General Hospital (1000-Bedded)., Tun Zaw Min ,   Consultant Pulmonologist, No. (1) Defence Services General Hospital (1000-Bedded)., Tun Kyaw Zwar ,   Consultant Pulmonologist, No. (1) Defence Services General Hospital (1000-Bedded)., Myo Aung ,   Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)., Swe Nyan Htut ,   Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)., Soe Nyein Chan ,   Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)., Tun Soe Moe ,   Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)., Lin Than Naing ,   Pulmonology Fellow, No. (1) Defence Services General Hospital (1000-Bedded)., Aung Han Lin ,   Assistant Lecturer / Consultant physician, Defence Services Medical Academy., Soe Nyan Naing ,   Assistant Lecturer / Consultant physician, Defence Services Medical Academy., Kyaw Myo Thant ,   Assistant Lecturer / Consultant physician, Defence Services Medical Academy., Aung Zay Phyo ,   Assistant Lecturer / Consultant physician, Defence Services Medical Academy., Myint Thein Tun ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Maung Kyaw Thet ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Min Sitt ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., War Saw Thar ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded)., Thu Aung ,   Consultant Physician, No. (1) Defence Services General Hospital (1000-Bedded).
Published: November 2022

A 50-year-old gentle man, coming back from Delta region, presented with, septic shock, ARDS and acute kidney injury following 8 days history of high fever. Eschar was noted on right forearm. His temperature was 105°F; very ill and toxic with SaO2 90% on air. He was hypotensive (80/50 mmHg), tachycardic (128/ min), tachypneic (respiratory rate 32/min) with low SaO2 (90% on air); crackles were audible in both lungs. Chest radiograph showed patchy opacities in both lungs. He had low Platelet count (34 x 109/mm3), raised serum creatinine (160 μmol/L), raised liver enzymes (SGOT 121 U/L & SGPT 86 U/L) and low serum albumin (22 mg%). Rapid test for Scrub Typhus IgM was positive. The patient recovered with oxygen therapy, fluid replacement, inotropes, cefopyrazone/salbactam and doxycycline.