Scrub Typhus Presenting as Acute Abdomen Complicated by Myocarditis and Acute Kidney Injury: A Case Report

Abstract

Scrub typhus is a multisystem infection that can mimic surgical and other infectious conditions, and delayed recognition may lead to fatal outcomes. We report a 14-year-old girl who presented with features suggestive of an acute abdomen, including abdominal pain, vomiting, loose stools, and marked guarding. Initial evaluation favored surgical and common infectious differentials, but investigations showed multisystem involvement, including leukocytosis with thrombocytopenia, hepatic dysfunction, renal impairment, and elevated D-dimer. Imaging revealed abdominal inflammatory changes and bilateral pulmonary opacities. In view of high-grade fever with thrombocytopenia and organomegaly, scrub typhus was suspected and confirmed by positive immunoglobulin M serology. During hospitalization, she rapidly deteriorated with hypotension and tachycardia requiring vasoactive support and intensive care. Respiratory distress progressed to hypoxemic respiratory failure with radiographic worsening consistent with acute respiratory distress syndrome, necessitating endotracheal intubation and invasive mechanical ventilation. Screening echocardiography demonstrated left ventricular systolic dysfunction with an ejection fraction of approximately 40% without supportive electrocardiographic changes or abnormal cardiac enzymes reported. She developed worsening acute kidney injury with metabolic acidosis and hyperkalemia, along with coagulopathy treated with blood products for disseminated intravascular coagulation. Despite escalation of antimicrobial therapy and organ support, she suffered sudden ventricular tachycardia and died within four days of presentation. This case highlights the need to consider scrub typhus in endemic settings when acute abdomen is accompanied by thrombocytopenia and early organ dysfunction, and to initiate targeted therapy promptly.