Symmetrical Peripheral Gangrene in an Indian Child with Severe Scrub Typhus

Scrub typhus is one of the common causes for acute febrile illness in monsoon and post-monsoon season in our region. It usually presents as fever, rash, and thrombocytopenia with or without multiorgan dysfunction syndrome (MODS). Infrequently, it can cause focal or symmetrical peripheral gangrene (SPG). Here, we report a 5-year-old female who presented with acute febrile illness with MODS and SPG in bilateral lower limbs. The diagnosis of scrub typhus was confirmed with positive scrub typhus IgM antibodies. She recovered completely after combination therapy with doxycycline and azithromycin, and organ supportive therapy (mechanical ventilation, vasoactive drugs, and continuous renal replacement therapy) in the pediatric intensive care unit.