Abstract
This case report documents a rare case of scrub typhus with multiple serious complications in a 8-year-old patient. Scrub typhus is usually more prevalent in adults, but serious complications in children are uncommon. This report examines a severe pediatric case involving septic shock, acute respiratory distress syndrome (ARDS), and hemophagocytic lymphohistiocytosis (HLH). The patient initially presented with erythema of the umbilicus, which then progressed to characteristic crusting with high fever, hepatosplenomegaly, and enlarged lymph nodes. Metagenomic next-generation sequencing (mNGS) confirmed the presence of Scrub typhus in the patient's blood sample. Notably, this is the first case of scrub typhus found in lung using mNGS, providing strong evidence for early detection. Treatment included a combination of antibiotics, particularly doxycycline and rifampicin, as well as supportive measures such as invasive mechanical ventilation, plasma exchange, continuous renal replacement therapy (CRRT) and chemotherapy. With this comprehensive treatment approach, the patient's condition gradually improved and he was eventually discharged with complete recovery. This case emphasizes the importance of timely and accurate diagnosis and multidisciplinary supportive care in the treatment of severe scrub typhus in children.