Atypical Case of Scrub Typhus

Scrub typhus, also called tsutsugamushi disease in Japan, is one of the most common rickettsial diseases in this country. Fever, skin rash, eschar and elevated hepatic enzymes are main clinical features of scrub typhus. We present the case of a 55 year-old woman contracted with this infection without skin eruption and abnormal liver function. The finding of an unusual eschar helped us to make a correct diagnosis. The fever subsided within 24 hours after minocyline therapy. Scrub typhus of Kuroki serotype was confirmed by indirect immunoperoxidase assay and nested polymerase chain reaction with her whole blood and eschar.