[Infection with Orientia tsutsugamushi and hospital-acquired pneumonia]

Tsutsugamushi fever is an infection caused by Orientia tsutsugamushi that is rarely diagnosed in Europe but endemic in several Asian countries and in Chile. Its clinical presentation is often nonspecific, ranging from fever, myalgia, lymphadenopathy, and a maculopapular rash to severe disease with multiorgan involvement.

A 34-year-old man presented with fever, myalgia, lymphadenopathy, and a maculopapular rash after returning from Thailand. Despite empiric antimicrobial therapy, his condition deteriorated rapidly, with respiratory failure, impaired consciousness, and hypotension. Polymerase chain reaction (PCR) testing of peripheral blood confirmed O. tsutsugamushi. Treatment with doxycycline, along with meropenem for hospital-acquired pneumonia, resulted in rapid clinical improvement.

This case highlights the importance of considering tsutsugamushi fever in febrile travelers returning from endemic regions. Timely presumptive or PCR-based diagnosis and initiation of effective therapy are crucial to prevent severe disease with multiorgan involvement and secondary complications.