Liver Failure, Renal Failure, and a Rash: An Unusually Severe Case of Multi-Organ Failure Due to Murine Typhus

Murine typhus is a vector-borne disease transmitted to humans via fleas and typically causes an infection hallmarked by nonspecific, mild symptoms of fever, rash, and headache. More severe diseases, while rare, can occur. We present a complicated case of murine typhus resulting in liver and renal failure. Our patient was a healthy 64-year-old Hispanic gentleman who presented to his local emergency department (ED) in Southwest Texas for fevers, chills, and myalgia progressing to dyspnea, fatigue, and jaundice. He was transferred to a Central Texas transplant hospital given concern for impending liver failure as well as acute kidney injury later requiring hemodialysis. Broad-spectrum antibiotics were narrowed to empiric doxycycline with eventual improvement in his lab values and symptoms. The return of Rickettsia typhi antibody lab values later revealed murine typhus to be the cause of his disease.