A Rare and Severe Multisystem Cascade of <scp>AKI</scp> , <scp>ARDS</scp> , and Septic Shock Leading to Acalculous Cholecystitis in a Young Scrub Typhus Patient: A Case Report From Nepal

Scrub typhus, caused by <i>Orientia tsutsugamushi</i>, is an acute febrile illness prevalent in Nepal with a wide spectrum of clinical presentations. Severe forms can lead to multiorgan dysfunction, including acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), septic shock, and rarely, acalculous cholecystitis. We report a case of a previously healthy 30-year-old female from Nepal presenting with fever, jaundice, and epigastric pain. Clinical evaluation revealed hemodynamic instability, respiratory distress, and an eschar on the lower extremity. Laboratory and imaging workup showed AKI, elevated liver enzymes, positive IgM and IgG for <i>O. tsutsugamushi</i>, gallbladder wall thickening without stones, and chest radiograph findings consistent with ARDS. She was diagnosed with scrub typhus complicated by AKI, ARDS, septic shock, and acute acalculous cholecystitis. The patient was treated promptly with doxycycline and supportive intensive care, including oxygen therapy, intravenous fluids, and antibiotics. Clinical and laboratory improvement ensued, and she was discharged in stable condition after 2 weeks of hospitalization. This case highlights the potential for severe multisystem complications of scrub typhus, including the rare occurrence of acalculous cholecystitis secondary to systemic vasculitis and shock. Early recognition and timely management in endemic regions are critical to improving outcomes.