Acute encephalitis syndrome caused by Orientia tsutsugamushi

Acute encephalitis syndrome (AES) secondary to scrub typhus infection is rarely seen clinically. A 50-year-old man was brought to our emergency department (ED) with weakness, disorientation, and bizarre behavior. An episode of generalized tonic-clonic (GTC) seizure occurred with urine and stool incontinence, and he became unresponsive. Glasgow Coma Scale score was E4V2M4. At ED, a physical examination revealed fever (body temperature: 39.4 ℃), tachycardia (pulse rate: 135 beats per minute), hypotension (systolic/diastolic: 77/61 mmHg), skin rashes over the trunk, disorientation, and two eschar lesions over his right chest wall and thigh, but no focal neurologic deficits. On the 4^th day of admission, real-time polymerase chain reaction test was positive for tsutsugamushi. Finally, he recovered and was discharged 9 days later. Scrub typhus is an acute mite-borne febrile illness caused by Orientia tsutsugamushi. Patients can present with non-specific flu-like symptoms, such as headache, myalgia, cough, nausea, and vomiting. In a scrub typhus emergency, acute febrile illness with central nervous system symptoms require timely diagnosis and treatment to prevent mortality and disease sequelae. This case highlights the need for a high degree of suspicion for AES secondary to scrub typhus to diagnose it early and to start specific treatment immediately. Patients usually recover soon with a good outcome.