Krattyfus

Background: A thirty-year old, previously healthy female was admitted to hospital due to fever and a generalised rash following travel to South-East Asia. She had participated in recreational activities in rural areas and sustained several insect bites. Case presentation: The patient presented with reduced general condition, fever, a generalised maculopapular rash and an eschar. Laboratory findings showed leucocytosis, neutrophilia, elevated CRP and liver enzymes, and hyponatraemia. Radiological imaging revealed bilateral reticular opacities and pleural effusions. Based on clinical suspicion of rickettsiosis, empirical doxycycline was initiated. Following discharge, test results confirmed scrub typhus, with positive Orientia tsutsugamushi IgG antibodies in serum and positive O. tsutsugamushi DNA from eschar tissue. Interpretation: Scrub typhus is a rare cause of rickettsiosis in returning travellers. Due to its often non-specific clinical presentation, misdiagnosis is common. Initiation of treatment depends on clinical suspicion, highlighting the need for awareness among clinicians in non-endemic regions.