A rare case of scrub typhus complicated by severe hemolytic anemia, septic shock, and multi-organ dysfunction in a patient with thalassemia

Scrub typhus, a re-emerging zoonosis caused by Orientia tsutsugamushi, can present with severe, life-threatening complications, including multi-organ dysfunction and hemolytic anemia. This report details the case of a 40-year-old female with underlying thalassemia who presented with symptoms initially suggestive of pyelonephritis but rapidly progressed to septic shock, multi-organ dysfunction syndrome, and a severe hemolytic crisis. Concurrent Escherichia coli and Enterococcus gallinarum pyelonephritis further complicated the clinical picture. Diagnosis was confirmed by the identification of a characteristic eschar and metagenomic next-generation sequencing. Targeted therapy with doxycycline and broad-spectrum antibiotics, alongside supportive care, led to a favorable outcome. This case underscores the protean manifestations of scrub typhus, highlights its potential to precipitate catastrophic hemolysis in patients with chronic hemolytic disorders, and demonstrates the critical role of advanced diagnostics and a high index of suspicion for dual pathology in guiding effective, life-saving management in endemic regions.