Scrub Typhus

An 8-year-old previously healthy boy was brought to the hospital with abrupt onset of fever for 5 days. He was treated with paracetamol initially and later oral cefixime by a practitioner. On day 4, he developed generalized rash and facial puffiness. On examination, he had a maculopapular rash over the trunk, limbs, and face sparing the palms and soles, generalized lymphadenopathy and hepatosplenomegaly. There was no eschar. A differential diagnosis of dengue fever/scrub typhus/enteric fever was made. The child was hospitalized, investigations were sent, and doxycycline and intravenous ceftriaxone were started empirically for scrub typhus and enteric fever, respectively. Dengue serology was negative, and IgM ELISA for scrub typhus was positive. His fever subsided in 48 h and general condition improved. Later, blood culture was also reported to be sterile and ceftriaxone was stopped. He was discharged, and doxycycline was given for a duration of 5 days. He was normal during a follow-up after 2 weeks.