Scrub typhus complicated by cholecystitis: a case report

Objective: Scrub typhus complicated by acute cholecystitis is rare. Scrub typhus lacks specific clinical manifestations in its early stage, especially in patients without eschars, requiring comprehensive diagnosis based on epidemiological history, clinical presentation, and laboratory results. This case report describes a patient with scrub typhus complicated by acute cholecystitis, ultimately confirmed by tNGS, reminding surgeons to emphasize physical examination and avoid diagnostic anchoring. Methods: We report a case of a 74-year-old female who presented with right upper quadrant pain and fever. Laboratory tests showed elevated white blood cell count and increased neutrophil percentage, while CT suggested chronic cholecystitis. The patient received anti-infective therapy with cefoperazone sodium and sulbactam sodium, as well as gallbladder puncture and drainage. However, her condition continued to deteriorate, with the development of multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC). She resided in a rural area of Guangzhou, China, but had not engaged in agricultural work. After transfer to the intensive care unit, an eschar was discovered on her lower back. The diagnosis was confirmed by targeted next-generation sequencing (tNGS) of blood samples. Active interventions including doxycycline anti-infective therapy, mechanical ventilation, blood purification, and blood transfusion were subsequently administered. Results: The patient's condition continued to deteriorate. During her ICU stay, she experienced one episode of cardiac arrest. Although spontaneous circulation was restored through aggressive resuscitation, the shock state remained refractory to correction. Given the poor prognosis and the unbearable burden of continued treatment, rehabilitation, and nursing care, the family ultimately chose to withdraw life-sustaining therapy. Conclusions: This case illustrates a patient with scrub typhus whose initial clinical presentation was an attack of cholecystitis. Delayed diagnosis led to rapid progression and deterioration of the patient's condition, ultimately resulting in death. This case reminds us that surgeons need to enhance their awareness of local epidemic diseases during outbreak seasons, emphasize physical examination, and promptly employ advanced diagnostic methods such as tNGS for difficult cases, thereby reducing the risks of misdiagnosis and missed diagnosis.