A Case Report of Scrub Typhus in Third Trimester of Pregnancy Leading to Multi-organ Dysfunction – A Lesson Learned.

Abstract Introduction: Scrub typhus in pregnancy may present with varying clinical spectrum ranging from mild febrile illness to multi-organ dysfunction. Severe form of untreated disease may result in maternal and/or fetal death. We present the case report of a primigravida in her third trimester of pregnancy with scrub typhus that faced “maternal near miss” and fetal demise. Case: A 25-year-old primigravidaat 36 weeks of gestation was referred to us with fever, headache, and malaise for 15 days and progressive dyspnea for two days. She was being treated with antipyretics and non-specific antibiotics before referral. She had tachycardia, hypotension, tachypnoea, orthopnea, oxygen saturation of 90% on room air, and generalized anasarca. Investigations revealed thrombocytopenia, deranged renal function tests, and increased procalcitonin. Azithromycin and ceftriaxone were started empirically. ELISA for Scrub typhus was positive. Subsequently, an eschar was found below left breast. Her condition improved with resuscitation, supportive therapy, and definitive treatment. Patient had spontaneous labor within 24 hours of admission resulting in vaginal delivery. She had intrapartum stillbirth. After delivery, she again developed respiratory distress requiring intubation. The chest Xray showed a deteriorating picture with consolidation in right upper lung and bilateral reticulo-nodular opacities. Antibiotics were switched to meropenem and doxycycline 100mg twice a day. Fever subsided after day-4 postpartum and she was gradually weaned off from the ventilator. Conclusions: It is important to consider this differential early in the course of illness especially in tropical countries. Delay in diagnosis and hence, treatment can result in catastrophic outcome.