Cellulitis that was NOT Cellulitis

Cellulitis is a common bacterial skin infection characterized by erythema, swelling, and pain of the affected skin and subcutaneous tissues. The lower limbs are a commonly affected area due to microtrauma and gravity-dependent stagnation of blood. We describe a case of a male patient with an extensive travel history who presented with left lower limb cellulitis, hyperbilirubinemia, and acute kidney injury. When workup for the usual causes of cellulitis did not provide a clearer picture, we had to consider the unusual. Considering his travel history, an exotic tropical zoonotic disease was considered, and an eschar was searched for. Upon further investigation, he tested positive for the Weil-Felix test and responded very well to doxycycline. Our case emphasizes the need to suspect scrub typhus in travelers, even with unusual presentations, for timely diagnosis and treatment to prevent the development of various complications and ensure earlier recovery of patients. It usually presents as an acute febrile illness, but the diagnosis is often missed due to similarities with other tropical febrile infections.