• De-Han Cai and Xiao-Lin Fang.
• Nephrology Department in Jiangxi Provincial People's Hospital, the First Affiliated Hospital to Nanchang Medical College, Nanchang, China.
• Medicine (Baltimore). 2024 Sep 27; 103 (39): e39879e39879.

RationaleScrub typhus is a mite-borne, acute febrile disease caused by Orientia tsutsugamushi. The endemic areas of scrub typhus are expanding, both globally and in China. Patients who are not treated promptly, are likely to die of multiple organ dysfunction syndrome.Patient ConcernsCase I A 61-year-old female patient complained of sudden chest tightness and shortness of breath accompanied by fever for 6 days. Case II A 54-year-old male patient complained of fever and cough for 4 days and renal insufficiency for 2 days.DiagnosesScrub typhus, multiple organ dysfunction syndrome.InterventionsAfter the definite diagnosis, both patients were treated with doxycycline and various organ supports.OutcomesThe patient in case I was ultimately not salvageable. The patient in case II was successfully cured by the prompt administration of doxycycline along with continuous renal replacement therapy.LessonsWith early diagnosis and treatment, patients can completely recover. Eschar, a characteristic sign of scrub typhus, is often overlooked, leading to delayed diagnosis and regrettable outcomes.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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