A case of acute pulmonary edema in scrub typhus: a rare complication with normal cardiac and renal function

Scrub typhus is a mite-borne rickettsial infection endemic to parts of Asia, including Sri Lanka, with a wide range of clinical manifestations. We report a rare case of a 16-year-old male who presented with a seven-day febrile illness complicated by hypoxemia and pulmonary congestion. Clinical examination revealed an eschar and inguinal lymphadenopathy, raising strong suspicion of scrub typhus, which was subsequently confirmed by a Weil-Felix OXK titer of 1:1280. Despite initial suspicion of myocarditis, cardiac and renal evaluations were normal, and the patient rapidly improved with doxycycline and low-dose frusemide. The clinical course, absence of organ dysfunction, and prompt radiological resolution supported a diagnosis of noncardiogenic pulmonary edema. ARDS was considered unlikely and was ruled out. This case highlights scrub typhus as a rare cause of pulmonary edema occurring in the absence of cardiac and renal involvement, underscoring the need for clinical awareness in endemic regions. Not applicable.