# Scrub Typhus Combined With Septic Shock Disseminated Intravascular Coagulation and Significant Hyperfibrinolysis: A Case Report and Review of the Literature

## TL;DR

A 68-year-old man with scrub typhus developed severe complications including septic shock and coagulation issues, showing unique hyperfibrinolysis not seen in typical sepsis.

## Contribution

This case highlights unique coagulation abnormalities in scrub typhus-associated DIC, differing from standard sepsis cases.

## Key findings

- Scrub typhus can cause DIC with significant hyperfibrinolysis.
- Antifibrinolytic therapy may be beneficial in such cases.
- No similar cases were found in existing medical literature.

## Abstract

Introduction: Scrub typhus is an acute infectious disease caused by Orientia tsutsugamushi, whose pathophysiology is characterized by systemic small-vessel vasculitis. Its high misdiagnosis rate stems from its nonspecific clinical features. If not diagnosed and treated in time, patients may rapidly progress to multiorgan dysfunction syndrome (MODS) or even disseminated intravascular coagulation (DIC), posing a severe threat to life.

Case Presentation: The patient was a 68-year-old male with “recurrent fever and dry cough for six days.” He was admitted to the hospital with a diagnosis of scrub typhus. After admission, he developed severe acute respiratory distress syndrome (ARDS), MODS, septic shock, DIC with thrombocytopenia, hypofibrinogenemia, significant hyperfibrinolysis, and myocardial depression. The patient improved following treatment with doxycycline, moxifloxacin, renal replacement therapy, blood transfusion, antifibrinolysis, invasive mechanical ventilation, and other supportive therapies. The patient's coagulation profile in DIC caused by scrub typhus demonstrated significant hyperfibrinolysis, differing from that of garden-variety sepsis, and no similar cases were identified in a search of medical literature/databases.

Conclusion: The fibrinolytic system in DIC caused by scrub typhus is excessively active, and antifibrinolytic therapy may benefit such patients. Further research on the distinct coagulation abnormalities in scrub typhus–associated DIC would be highly valuable compared to sepsis-associated DIC.