Scrub Typhus-Associated Acute Pancreatitis: A Comprehensive Review and New Case Series

Scrub typhus, caused by Orientia tsutsugamushi, is a common endemic vector-borne disease in Asia that can lead to a range of systemic complications, including the rare but potentially life-threatening manifestation of acute pancreatitis. We conducted a systematic review of all reported cases of scrub typhus-associated acute pancreatitis from 1943 to 2024 using PubMed, including English, Japanese, and Chinese literature, and analyzed a total of 14 cases, including one newly identified case at our institution. Diagnostic criteria were based on compatible clinical features, elevated pancreatic enzymes, and characteristic imaging findings. The median age of patients was 47 years (range 22-75), with 69.2% of patients being male. The most frequent clinical manifestations were fever (100%), abdominal pain (92.3%), and thrombocytopenia (30.8%). Over one-third of the patients developed multiple organ dysfunction syndrome (MODS) or shock, and the mortality rate was 23.1%, with all fatalities occurring in patients with MODS. Most patients received doxycycline or azithromycin along with supportive care. The newly reported case presented with rapidly progressive pancreatitis requiring intensive care and multiple organ support, but the patient eventually recovered. These findings highlight that acute pancreatitis is an underrecognized yet severe complication of scrub typhus, often associated with poor outcomes when MODS is present. Clinicians in endemic regions should consider pancreatitis in the differential diagnoses when evaluating scrub typhus patients with abdominal symptoms or systemic inflammation. Prompt recognition and timely, aggressive management may improve survival and reduce complications in affected patients.