Massive splenomegaly in scrub typhus: A rare presentation

Scrub typhus, an acute rickettsial febrile illness, is an emerging cause of prolonged fever and Pyrexia of Unknown Origin(PUO). Scrub typhus infection can have myriads of clinical manifestations ranging from mild asymptomatic disease to fatal multi-organ failure. Massive splenomegaly in scrub typhus is rarely reported. We present a diagnostic conundrum of a 22 year old male presenting with fever, hepatomegaly, massive splenomegaly and lymphadenopathy. Tests for malarial parasite, visceral leishmaniasis, enteric fever were negative. Bone marrow aspiration showed normal hemopoeisis. IgM Scrub tested positive. High grade of clinical suspicion and awareness is required among treating physicians for early diagnosis of scrub since delay in treatment initiation may lead to a dismal clinical outcome.