Congenital scrub typhus presenting as non-immune hydrops fetalis

Congenital scrub typhus is a rare form of Orientia tsutsugamushi infection in neonates. Typical neonatal manifestations include fever, thrombocytopenia and hepatosplenomegaly; however, presentation in the form of non-immune hydrops fetalis (NIHF) is uncommon and has not been reported previously in literature. We report a case of vertically transmitted scrub typhus in a preterm neonate who presented with hydrops fetalis at birth. The diagnosis was established using molecular testing, and timely initiation of appropriate antimicrobial therapy resulted in complete recovery. This case and the accompanying literature review expand the clinical spectrum of congenital scrub typhus and highlight the importance of considering it as a treatable infectious cause of NIHF in endemic regions.