Acute Pancreatitis - A Rare Manifestation in Scrub Typhus

Background: Scrub typhus is an acute febrile illness caused by the bacteria - Orientia tsutsugamushi, transmitted through the bite of an infected chigger. This infection is endemic in tropical countries like India, Pakistan, and Bangladesh. It usually presents with fever, headache, myalgia, nausea, vomiting, abdominal pain, and tender lymphadenopathy. The presence of an eschar clinches the diagnosis clinically. Commonly encountered complications in scrub typhus include acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), acute liver injury, and rarely acute pancreatitis. Case Presentation: We report a case of a 70 year-old teetotaller male, who presented with acute febrile illness and respiratory distress during the peak period of the COVID -19 pandemic. During the course of illness, the patient developed acute pancreatitis as evidenced by elevated serum amylase and lipase as well as features of pancreatitis in the CT abdomen. Common causes of acute pancreatitis were ruled out with necessary investigations. He tested negative for malaria, dengue fever, enteric fever, and leptospirosis, but his IgM and IgG ELISA for scrub typhus were positive with high titres. He also had AKI, ARDS, and acute liver injury. The patient was treated symptomatically and with doxycycline. His condition improved gradually. Conclusion: Even though acute pancreatitis is one of the rare manifestations of scrub typhus, it should be suspected early and treated promptly.