Manifestation of acute peritonitis and pneumonedema in scrub typhus without eschar: A case report

BACKGROUND Scrub typhus is an acute infectious disease caused by rickettsia infection. The diagnosis is based on eschar, and clinical manifestations can range from asymptomatic to multiorgan dysfunction. CASE SUMMARY We report the case of a 35-year-old man living in Zhuhai, Guangdong, China, who had repeated high fever with a maximum body temperature of 40.2 degrees C and elevated white blood cells and procalcitonin levels. After 7 d of persistent high fever, the patient developed rash, abdominal pain, and symptoms of peritonitis. Within 24 h after admission, the patient developed diffuse peritonitis and pneumonedema, requiring ventilator support in the intensive care unit. However, there was no eschar on the body, and the first Weil-Felix test was negative. Taking into account that the patient had a history of jungle activities, doxycycline combined with meropenem was selected. The patient improved, healed, and was discharged after a week. The diagnosis of scrub typhus was confirmed by a repeat Weil-Felix test (Oxk 1:640), and pathology of the appendix resected by laparotomy suggests vasculitis. CONCLUSION This rare presentation of peritonitis, pulmonary edema, and pancreatitis caused by scrub typhus reminds physicians to be alert to the possibility of scrub typhus.