Veins in Turmoil: Systemic Vasculitis-Induced Venous Incompetence in a Case of Leptospira and Scrub Typhus Co-Infection: A Case Report

A 48-year-old male presented with acute undifferentiated febrile illness complicated by a dual infection with leptospirosis and scrub typhus, manifesting with prolonged fever, rash, bilateral lower limb edema, thrombocytopenia, and acute liver injury. The patient had a history of recent travel and an unknown insect bite. On examination, bilateral pitting pedal edema, erythematous plaques, conjunctival suffusion, and a healing arthropod bite were noted. Laboratory results showed severe thrombocytopenia, elevated liver enzymes, and positive serology for both leptospirosis and scrub typhus. Imaging with Doppler ultrasound revealed venous insufficiency with left saphenofemoral junction incompetence and multiple varicosities. The patient was treated with doxycycline and ceftriaxone, along with supportive care, resulting in gradual resolution of fever, myalgia, and pedal edema. This case highlights the overlapping clinical features and seasonal epidemiology of leptospirosis and scrub typhus, zoonotic infections that may lead to systemic vasculitis affecting multiple organs including the venous system. The inflammatory vasculitis likely contributed to transient venous insufficiency causing pedal edema and varicosities, as confirmed by duplex imaging that later normalized with clinical recovery. The report emphasizes the diagnostic challenge posed by coinfections and the importance of considering tropical febrile illnesses with vasculitic manifestations in endemic areas. It also discusses the pathogenetic mechanisms linking vasculitis and venous insufficiency and the need for further research on their interplay. Early recognition and combination antibiotic therapy led to a favorable outcome in this complex clinical scenario. This case adds to the limited literature on scrub typhus and leptospirosis coinfection presenting with atypical venous pathology and underscores the value of detailed clinical and radiological assessment in febrile patients with edema and rash.