Scrub typhus with massive reversible splenomegaly and gastroduodenal ulcers

Background: Scrub typhus, a zoonotic illness caused by Orientia tsutsugamushi, is asignificant cause of acute undifferentiated febrile illness in endemic regions. Whilehepatosplenomegaly is a common feature, massive splenomegaly and gastrointestinalulceration are rare.Case Presentation: We report the case of a young adult male who presented with highgrade fever, jaundice, abdominal pain, hypotension and melena. Examination revealedmassive splenomegaly and hepatomegaly. Laboratory findings showed cytopenias,liver dysfunction and acute kidney injury. Imaging confirmed massive splenomegaly,and upper gastrointestinal endoscopy revealed gastric and duodenal ulcers. Extensiveworkup for common causes of massive splenomegaly, including malaria andleishmaniasis, was negative. Serology for scrub typhus came out positive. The patientwas started on doxycycline, resulting in rapid clinical improvement, resolution of organdysfunction and normalization of spleen size.Conclusion: Scrub typhus should be considered in the differential diagnosis of feverwith massive splenomegaly, especially in endemic areas. When encountering massivesplenomegaly, thorough investigation is imperative to determine its cause. Beforeresorting to invasive procedures, it's crucial to rule out infectious causes. Scrub typhus,for instance, can manifest as fever with reversible massive splenomegaly uponappropriate therapy