Multiple Eschars in Scrub Typhus

A 47-year-old male presented with a 7-day history of intermittent fever, chills, rigors, and generalized weakness. Physical examination revealed low blood pressure, elevated pulse rate, and abnormal laboratory findings including low hemoglobin, elevated leukocyte count, low platelet count, elevated bilirubin and liver enzymes, and increased international normalized ratio. The patient had two eschars on examination. Serum IgM ELISA and nested polymerase chain reaction confirmed the presence of Orientia tsutsugamushi, a causative agent of scrub typhus. The patient was treated with doxycycline and recovered without relapse. Other tropical infections were ruled out.