Renal and prostatic abscesses: rare complications of scrub typhus

Background: Scrub typhus, also known as bush typhus, is a zoonotic infection caused by Orientia tsutsugamushi, a gram-negative intracellular bacterium transmitted by the larval stage of trombiculid mites (chiggers). It is endemic in the “tsutsugamushi triangle,” including parts of Southeast Asia and India. The disease usually presents with fever, headache, myalgia, lymphadenopathy, and hepatosplenomegaly. However, atypical manifestations involving the renal or prostatic systems are rare, and intra-abdominal abscess formation is an uncommon complication. Case Presentation: A 57-year-old male from Udaipur, Rajasthan, presented with high-grade fever for five days, headache, and diffuse abdominal pain for three days. Clinical examination revealed pallor and mild abdominal tenderness without rash or eschar. Laboratory findings showed anemia (Hb 9 g/dl), thrombocytopenia (52,000/µl), and mildly elevated urea (55.6 mg/dl). Scrub typhus IgM ELISA was positive, while dengue and malaria tests were negative. Abdominal ultrasonography demonstrated a renal abscess (42×29 mm) in the left kidney and multiple prostatic abscesses. Blood and urine cultures were sterile. The patient was treated with intravenous doxycycline (100 mg BD) and azithromycin (500 mg OD) for 10 days, resulting in complete resolution of symptoms and normalization of laboratory parameters. Discussion: Scrub typhus can present with a wide range of clinical manifestations. Although hepatic and renal dysfunction are common, abscess formation in the kidneys or prostate is exceedingly rare. Abscesses may develop due to localized necrosis or secondary bacterial infection. Early imaging and appropriate antibiotic therapy are crucial for diagnosis and management. Conclusion: This case underscores the importance of considering scrub typhus in patients with unexplained febrile illness and intra-abdominal abscesses in endemic regions. Prompt recognition and doxycycline-based therapy can prevent severe complications and improve patient outcomes.