Acute abdomen caused by scrub typhus: A case report

Scrub typhus is an endemic disease in Pescadores island, Taitung county and other small islands around Taiwan. It usually presents clinically as fever, chillness, rash, eschar, cough, dyspnea and lymphadenopathy. We present a 28 year-old male from Nantou county suffering from acute abdomen, fever and headache on admission. Emergent laparotomy was performed under the impression of intestinal perforation caused by typhoid fever, but only mesenteric lymph node enlargement and ascites were noted. As an eschar at the left flank and skin rashes over the chest wall were noted, tetracycline was prescribed under the impression of scrub typhus. The clinical condition of this patient improved gradually and the diagnosis of scrub typhus was confirmed through the positive result of Rickettsia IgM antibody. We report this case because acute peritonitis induced by scrub typhus is a rare presentation.