Scrub Typhus Presenting as Multi-Lobar Community-acquired Pneumonia

Abstract The clinical spectrum of scrub typhus varies widely, from mild febrile illness to life-threatening complications, often resulting in clinical dilemmas. Scrub typhus may be overlooked in classical community-acquired respiratory infections. This report presents a case of elderly male whose symptoms and radiological findings strongly suggested multi-lobar community-acquired pneumonia. The diagnosis became clear on day 4 when an abdominal Eschar was noted, prompting serological confirmation of scrub typhus. The subsequent treatment modification led to the patient’s full clinical recovery. This case underscores the need to consider scrub typhus as a potential cause of pneumonia, especially in the endemic regions. It is also important to note that empirical and conventional beta-lactam antibiotics for the treatment of pneumonia might not benefit scrub typhus pneumonia. Given the varied manifestations of scrub typhus and absence of the pathognomonic eschar in a significant number of patients, its diagnosis requires a high degree of suspicion.