A 16-Year-Old Boy With ARDS and Septic Shock, an Atypical Presentation of Murine Typhus: Case Report and Review of the Literature.

Murine typhus is a flea-borne disease caused by the bacteria Rickettsia typhi that occurs worldwide, but predominantly in endemic areas. The clinical presentation of typhus is often nonspecific, leading to delays in diagnosis and treatment. The severity of the disease varies widely. Most cases are relatively mild, but some patients develop a very severe form and may die. We report a case of severe murine typhus complicated by septic shock, alveolar hemorrhage, and acute respiratory distress syndrome in a teenager who was born in Somalia and had immigrated from Kenya to Switzerland. Diagnosis was suspected upon admission in the pediatric intensive care unit and was confirmed by PCR. The patient improved with doxycycline treatment. Rickettsial disease should be considered in the differential diagnosis of patients returning from endemic areas, and anti-rickettsial treatment should be started without delay to ensure rapid recovery and avoid severe complications.