Reversible high-grade AV block in a patient with scrub typhus

A man in his late 30s presented with a prolonged febrile illness and recurrent syncopal episodes. Physical examination revealed hypotension, bradycardia and eschars on the bilateral thighs. A 12-lead ECG showed complete heart block with wide QRS escape rate of 30 beats per minute. Laboratory tests confirmed scrub typhus with elevated cardiac markers. The patient was managed with a temporary transvenous pacemaker and intravenous doxycycline which led to rapid resolution of symptoms and complete normalisation of cardiac conduction within 48 hours. This case highlights the importance of scrub typhus in the differential diagnosis of febrile illnesses with conduction abnormalities, especially in endemic areas.