Journal of Innovative Clinical Trials and Case Reports

Abstract

Scrub typhus, caused by Orientia tsutsugamushi, is a common acute febrile illness in the Asia–Pacific region, with clinical manifestations ranging from mild fever to multiorgan dysfunction. Hepatic involvement is frequently reported; however, severe hepatitis with jaundice is uncommon. Cardiac complications such as arrhythmias are recognised, although sinus bradycardia remains a rare finding. The coexistence of severe hepatitis and bradyarrhythmia is unusual and may pose diagnostic challenges.

We report the case of a 46-year-old woman who presented with a 7-day history of fever, progressive jaundice, and oliguria. She exhibited severe sinus bradycardia, hypotension, metabolic acidosis, and laboratory evidence of acute hepatitis and kidney injury. Serology confirmed scrub typhus. The patient was treated with intravenous doxycycline and supportive therapy, including vasopressors. Bradycardia was managed conservatively and resolved without pacing. She achieved complete recovery, with normalisation of hepatic, renal, and cardiac parameters within a week.

This case highlights an atypical presentation of scrub typhus characterised by severe hepatitis and sinus bradycardia. Early recognition and timely initiation of doxycycline are essential for favourable outcomes and may prevent unnecessary invasive interventions in endemic regions.