Case Report: Severe sepsis due to imported scrub typhus in a German traveler returning from Vietnam

Scrub typhus, caused by the obligate intracellular bacterium Orientia (O.) tsutsugamushi, is an under-recognized cause of febrile illness in travelers returning from endemic regions of the Asia-Pacific. We report the case of a 39-year-old woman who presented with high-grade fever, headache, and hepatitis with coagulopathy following travel to Vietnam. Her condition deteriorated rapidly progressing to sepsis. Laboratory investigations revealed hemolysis with mild anemia, thrombocytopenia, as well as markedly elevated liver enzymes and inflammatory markers. Computed tomography demonstrated extensive bilateral pulmonary infiltrates and pleural effusions consistent with a clinically impending acute respiratory distress syndrome (ARDS). A positive polymerase chain reaction (PCR) for O. tsutsugamushi from EDTA blood confirmed the diagnosis. The patient improved under the empirically initiated doxycycline therapy. This case highlights the importance of considering scrub typhus as a potentially life-threatening yet treatable cause of febrile illness in travelers returning from endemic regions. Given its diverse clinical manifestations and lack of coverage by beta-lactams that are usually applied for empirical sepsis therapy, heightened clinical awareness and timely diagnostic testing are crucial - particularly in the context of expanding endemic areas and increasing global mobility.