• Prabin Khatri, Ashutosh Upadhyaya, Nirajan Kandel, Shriya Upadhyaya, and Himal Panth.
• Department of Clinical Immunology and Rheumatology, Medanta Institute of Education & Research, Gurugram, Haryana, India.
• JNMA J Nepal Med Assoc. 2023 May 1; 61 (261): 475478475-478.

UnlabelledScrub typhus is common in rural Nepal's southern plains, but its diagnosis remains difficult due to a lack of clinical suspicion and poor diagnostic resources. The absence of common manifestations of the condition including eschar might further complicate this problem and may result in treatment delays. We report a case of scrub typhus with the primary presentation of reactive monoarthritis of the left hip joint in a 19-year-old male who presented with difficulty in walking, and pain over the left hip joint. Ultrasonography of the left hip and thigh showed features of synovitis and iliopsoas bursitis. After a meticulous workup, a diagnosis of human leukocyte antigen B27 negative reactive monoarthritis of the left hip joint triggered by scrub typhus infection was made and the patient was treated with doxycycline. Delays in treatment and the rate of complications can be prevented with high clinical suspicion and awareness of the atypical presentation of the condition.KeywordsHLA-B27; case reports; reactive arthritis; scrub typhus.

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