Scrub typhus is an endemic disease, caused by Orientia tsutsugamushi. Typical presentations include fever, headache, eschar, rash, and ...NCBISkiptomaincontentSkiptonavigationResourcesHowToAboutNCBIAccesskeysMyNCBISignintoNCBISignOutTryoutPMCLabsandtelluswhatyouthink.LearnMore.JournalListBMJCaseRepv.2010;2010PMC3028930BMJCaseRep.2010;2010:bcr10.2009.2356.Publishedonline2010Feb8.doi: 10.1136/bcr.10.2009.2356PMCID:PMC3028930PMID:22315642ImagesIn...MarkofscrubtyphusBor-JenLee,Yau-LinWang,andChe-AnTsaiAuthorinformationCopyrightandLicenseinformationDisclaimerTaichungVeteransGeneralHospital,IntensiveCareUnit,DepartmentofInternalMedicine,No.160,Sec.3,Chung-KangRoad,Taichung,00407,TaiwanCorrespondencetoYau-LinWang,ten.tenih.asm@icyek.icyekCopyright2010BMJPublishingGroupLtdA23-year-oldpreviouslyhealthymalesoldierpresentedwithintermittentfever,generalisedskinrashes,andahistoryofrightearachefor11days.Hehadrecentlyperformedmilitarytrainingongrassbeforehispresentation.Initially,otitismediawasdiagnosed,buthisearachedidnotimproveafterantibiotictreatment(amoxicillin/clavulanate,thenimipenem/cilastatinsodium).Thepatient’sconditionprogressedtoacuterespiratorydistresssyndrome,andrequirementforendotrachealintubationforrespiratoryfailure.Physicalexaminationrevealedgeneralisedmorbiliformskinrashes,subconjunctivalhaemorrhage,butnoescharwasfoundonthetrunk,extremity,axilla,orgroinarea.Laboratorydatashowedelevatedglutamicoxaloacetictransaminase/glutamicpyruvictransaminase(GOT/GPT)andthrombocytopenia.Otoscopicexaminationrevealedanescharlesionovertherightexternalearcanal(figs1and​and2).2).TheproteusOXtitrewas1:1280.Defervescenceoccurredin24hafterintravenousminocyclineadministration,withgradualsubsidenceoftheskinrashes.Scrubtyphuswasconfirmedbythefollowingserologydata(IFA-IgG1:640,IFA-IgM>1:160).OpeninaseparatewindowFigure1Arrowpointstoanescharlesionontheexternalearcanal.OpeninaseparatewindowFigure2Otoscopicviewshowsescharlesion.Scrubtyphusisanendemicdisease,causedbyOrientiatsutsugamushi.Typica