An unusual site of chigger bite in a patient with scrub typhus

A 70-year-old female farmer was admitted to the hospital because of fever, headache, and diarrhea for 7 days. Hypotension, right-sided pleural effusio n with respiratory distress and leukocytosis were noted. She was initially treated as systemic bacterial infection by IV administration of ampicillin/ sulbactam and amikacin. Because fever persisted in spite of aggressive trea tment, a repeat thorough physical examination was done. An eschar was found over the left-sided labium majus and an enlarged lymph node was noted over the left inguinal region. Under the impression of scrub typhus, minocyclin e was administered. The patient's clinical condition improved dramatically within 3 days. The diagnosis was later confirmed by a serologic test for Ri ckettsia tsutsugamushi. (C) 1999 Elsevier Science Inc.