Atypical presentation and response to treatment in scrub typhus: a series of 2 cases

Scrub typhus is an acute febrile illness caused by Orientia Tsutsugamushi. It usually presents with high fever, lymphadenopathy, rash, organomegaly and an eschar formation at the site of the bite. Doxycycline is the drug of choice usually showing rapid defervescence, but rarely some cases does not respond. Here, we present 2 such cases that did not respond to Doxycycline and had atypical presentation. Our first case presented with a fever for 15 days and then went into shock and multiorgan dysfunction despite having no fever after admission. Our second case presented in status epilepticus and septic shock. He developed purpura fulminans even after starting treatment. Both the cases did not respond to Doxycycline. The diagnosis was confirmed by Scrub Typhus IgM Antibody positivity. They were successfully treated with second-line drugs i.e. Azithromycin and Chloramphenicol.