Ilka Grewe, Saskia Winzer, Silja Steinmann, Paul Francke, Aiman Gamal Abdelrahim, Annette Hennigs, Marylyn M. Addo, Michael Ramharter, Dominic Wichmann, Stefan Schmiedel
BACKGROUND: Tsutsugamushi fever is an infection caused by Orientia tsutsugamushi that is rarely diagnosed in Europe but endemic in several Asian countries and in Chile. Its clinical presentation is often nonspecific, ranging from fever, myalgia, lymphadenopathy, and a maculopapular rash to severe disease with multiorgan involvement. CASE REPORT: A 34-year-old man presented with fever, myalgia, lymphadenopathy, and a maculopapular rash after returning from Thailand. Despite empiric antimicrobial therapy, his condition deteriorated rapidly, with respiratory failure, decreased vigilance, and hypotension. PCR testing from peripheral blood confirmed Orientia tsutsugamushi. Treatment with doxycycline, along with meropenem for hospital-acquired pneumonia, resulted in rapid clinical improvement. CONCLUSIONS: This case highlights the importance of considering tsutsugamushi fever in febrile travellers returning from endemic regions. Early presumptive or PCR-based diagnostics and initiation of effective therapy are crucial to prevent severe disease with multiorgan involvement and secondary complications.