A suspected surgical case of acute abdomen: A case report of scrub typhus

Abstract

Introduction: Scrub typhus presents with diverse clinical manifestations which range from sub-clinical disease to organ failure and fatal disease.

Case presentation: The patient presented with fever followed by acute abdominal pain and later developed septic shock with multi-organ failure. Radiological evaluations were normal, however, on thorough physical examination, an eschar was found in her right inguinal region.

Clinical discussion: Aside from classical clinical symptoms, it can also involve various organs, most commonly of respiratory, cardiovascular and hepatic systems. Additionally, suspected patients should be thoroughly examined for the presence of an eschar, especially over the covered areas such as the groin, genitalia, infra-mammary area and axilla.

Conclusion: Scrub typhus should be considered in all patients from an endemic area presenting as acute undifferentiated febrile illness associated with organ involvement. Positive finding of an eschar and high index of suspicion for the various presentations of scrub typhus can avoid unnecessary surgical exploration and aid in prompt diagnosis and treatment.

Keywords: Abdominal Pain; Fever of Unknown Origin; Multiple Organ Failure; Scrub Typhus; Septic Shock.

Fig. 1

Eschar in the right inguinal region on the anterior abdominal wall.

Fig. 2

Timeline of events and interventions (OTC: over-the-counter; MOF: Multi-organ failure; USG: ultrasonography; CECT: Contrast Enhanced Computed Tomography; ELISA: Enzyme Linked Immunosorbent Assay).