# Acute Pyelonephritis by Scrub Typhus: A Rare Condition

## TL;DR

A 53-year-old diabetic woman with septic shock was found to have a rare case of acute pyelonephritis caused by scrub typhus, highlighting the importance of considering atypical infections.

## Contribution

Reports a rare case of acute pyelonephritis caused by scrub typhus, emphasizing the need for broader diagnostic consideration.

## Key findings

- Scrub typhus can present as acute pyelonephritis with septic shock.
- Sterile urine cultures and IgM testing helped confirm the atypical diagnosis.
- Treatment with doxycycline led to significant clinical improvement.

## Abstract

Scrub typhus is prevalent in tropical countries and can have a varied spectrum of presentations from pneumonia, gastroenteritis, lymphadenitis, meningitis, encephalitis, and acute kidney injury to multi-organ dysfunction syndrome. Urinary tract infections like cystitis and pyelonephritis are rarely reported.

Here we present an atypical presentation of a 53-year-old female with diabetes mellitus who came to the outpatient department with complaints of high-grade fever, burning micturition, and left flank pain for three days and was initially treated outpatient basis with oral antibiotics. However, her deteriorating condition landed her in an emergency in a state of septic shock. She was initially treated with broad-spectrum conventional antibiotics with other supportive medications. Even after confirmation of the diagnosis of left acute pyelonephritis with septic shock, with appropriate antibiotics, her condition was deteriorating. A sterile urine culture raised suspicion of atypical organisms causing the infection. Proper analysis of her history and readily available investigations of IgM against scrub typhus antigen led to a diagnosis of scrub typhus-related left acute pyelonephritis with septic shock. She was treated adequately with an injection of doxycycline, followed by oral tablets of the same, after which she showed drastic improvement in her symptoms, and then she was discharged.

Thus, atypical organisms causing urinary tract infections should be kept always in mind, which can be treated easily and if untreated, can lead to life-threatening consequences.