We describe a rare case of acute transverse myelitis associated with scrub typhus. Magnetic resonance imaging scans, clinical characteristics, skin biopsy, and cerebrospinal fluid cytology confirmed a diagnosis of acute transverse myelitis associated with scrub typhus. To our knowledge, this was not seen in a prior publication. Our case indicates that Orientia tsutsugamushi can invade spinal cord. (C) 2008 Elsevier Inc. All rights reserved.