Myocarditis with Unidigital Gangrene in Scrub Typhus Patient – Rare Case

Scrub typhus is a mite-borne infectious disease caused by Orientia tsutsugamushi, an obligate intracellularbacterium. The disease is of greatest public health importance in rural areas of Asia and the Western Pacific Islands. Theclinical manifestations range from subclinical disease to organ failure. The chief target of organism is the vascular endotheliumof various organs. There is inflammation in and around the blood vessels that causes endothelial damage resulting invascular leakage and organ dysfunction. Case report: A 70-year-old female patient, farmer by occupation, presented tous with features of acute febrile illness and shortness of breath and was diagnosed as scrub typhus with myocarditis. Shesubsequently developed gangrene of right little finger. The patient was investigated for infectious and noninfectious causesof vasculitis leading to gangrene. We established that the cause for gangrene was scrub typhus as evidenced by presence ofeschar and positive serology. Conclusion: We report for the first time a case of scrub typhus complicated by both myocarditisand gangrene. Both myocarditis and unidigital gangrene are unusual complications of scrub typhus. Hence, scrub typhusshould be ruled out in patients who present with these complications.