Acute Respiratory Distress Syndrome – If Not COVID, What Else?

Acute respiratory distress syndrome (ARDS) became synonymous with COVID 19 infection during recent pandemic. We report this case who presented with fever and ARDS and had bilateral pneumonia on chest X-ray. After hospitalization he deteriorated and required invasive ventilatory support. His RT PCR for COVID 19 was repeatedly negative. So, he was screened for other infections causing ARDS. He had no eschar clinically but had other clues like leucocytosis, transaminitis, hypoalbuminemia and thrombocytopenia. On investigations his serology for Scrub Typhus was positive. He was given Doxycycline to which he responded dramatically and was weaned off ventilator.