Eschar: a cutaneous clue to scrub typhus.

60-year-oldmanpresentedwith a seven-day history of fever, eadache, fatigue, and decreased urine output. On examinaion, he was febrile (38 ◦C), and had tachycardia. A blackish kin lesion was noted on the right side of his neck (Fig. 1). scharwas not preceded by any pain or itching. His hemogram evealed a hemoglobin count of 11.8 gm/dL, total leukocyte ount of 6300/mm3, and a platelet count of 80,000/mm3. His iver functions were normal except for transaminase elevaion (SGPT: 112U/mL, SGOT: 120U/mL). His kidney function ests and urine analysiswere normal. Blood andurine cultures howed no growth.Weil Felix reactionwas positive for OX-K in titer of 1:160. DNA polymerase chain reaction (PCR) forOrienia tsutsugamushiwas positive in a blood sample. A diagnosis of crub typhus was established. The patient was managed with oxycycline and supportive measures. The patient improved ithin the following five days. Scrub typhus, a mite-borne infection caused by Orientia sutsugamushi, is very common in the Asia-Pacific region.1,2 he disease is so called because of the type of vegetation here the mite is present. The mite bites are painless and the esion begins as a red induration, that eventually vesiculates 2 nd ruptures to form an eschar. The patients may present ith fever, headache, myalgia, and hearing loss, which can e complicated by encephalitis, hepatitis, and pulmonary and