Scrub typhus presenting with massive splenomegaly and lobar pneumonia

Scrub typhus is still an underdiagnosed disease despite an increase in incidence as the clinical presentation is often different, leading to a low index of suspicion among doctors. Scrub typhus, an acute febrile disease, is a cause of prolonged fever and pyrexia of unknown origin. It can have varied clinical presentations ranging from mild asymptomatic disease to fatal multi-organ dysfunction. Splenomegaly in scrub typhus has been rarely reported. We report a 30-year-old man presenting with fever, hepatomegaly, massive splenomegaly, lymphadenopathy and lobar pneumonia. Tests for malarial parasite and enteric fever were negative. Bone marrow aspiration showed normal haematopoiesis. IgM scrub was positive. Upon serological confirmation, doxycycline therapy was started followed by a rapid and complete resolution of pneumonia (both clinically and radiologically), splenomegaly and lymphadenopathy. This highlights the importance of recognizing rare clinical manifestations of this common tropical disease. An early diagnosis is required as a delay may lead to complications and a poor outcome.