Scrub typhus complicated by acute pancreatitis: a rare case report from South India

The Gram-negative bacterium Orientia tsutsugamushi causes Scrub typhus, a mite-borne infection prevalent in southern India and other parts of Asia. This case study focuses on a 45-year-old man who developed multi-organ dysfunction after presenting with a low-grade fever, cough, and an eschar on his upper back for 15 days. The patient exhibited elevated liver enzymes, renal impairment, and severe hypertriglyceridemia, resulting in acute pancreatitis and respiratory distress that required intubation. The diagnosis was validated by the presence of positive IgM antibodies for scrub typhus, while a CT scan revealed acute pancreatitis. Despite no gallstones seen on ultrasound, serum amylase and lipase levels were significantly elevated, along with a triglyceride level of 1008 mg/dL. Management included intravenous doxycycline for Scrub Typhus, piperacillin-tazobactam for multi-organ dysfunction, and insulin infusion to reduce triglycerides, leading to improved enzyme levels and renal function. This case highlights the serious complications associated with Scrub typhus, such as acute pancreatitis, and underscores the importance of timely diagnosis and comprehensive management in endemic areas to enhance patient outcomes.