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Acute intravascular haemolysis associated with scrub typhus
  1. Debapratim Ganguly1,
  2. Atanu Chandra2,
  3. Swarnojit Maitra1 and
  4. Shobhan Lal Malakar1
  1. 1Internal Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
  2. 2Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
  1. Correspondence to Dr Atanu Chandra; chandraatanu123{at}


Scrub typhus, a prevalent tropical infection, may sometimes manifest with unusual complications. Here, we present the case of a young man who was admitted to our facility with a fever for the past 3 days and passage of dark-coloured urine since that morning. On investigation, we identified intravascular haemolytic anaemia. Through meticulous examination, a black necrotic lesion (eschar) was discovered on his right buttock, a pathognomonic sign of scrub typhus infection. Treatment was initiated with oral doxycycline 100 mg two times a day. Subsequently, diagnosis of scrub typhus was confirmed through positive results from scrub typhus IgM via ELISA and PCR analysis from the eschar tissue. The patient responded well to oral doxycycline and his symptoms resolved within the next few days. This case highlights severe intravascular haemolysis associated with scrub typhus infection.

  • Doxycycline
  • Tropical medicine (infectious disease)
  • Haematology (incl blood transfusion)
  • General practice / family medicine

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: AC and DG prepared the manuscript with adequate planning and execution. DG, SLM and SM contributed to patient management, review of literature, critical revision of content and final approval of manuscript. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The following authors gave final approval of the manuscript: AC, DG, SLM, SM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.