A 10-year-old child from New York presented with high fever, rash, headache, and myalgia after returning from Bangladesh. Initial evaluation revealed thrombocytopenia, elevated liver enzymes, and C-reactive protein, but malaria, dengue, and leptospirosis tests were negative. An eschar on the left flank, consistent with a chigger bite, raised suspicion for scrub typhus. PCR testing of the eschar confirmed Orientia tsutsugamushi, leading to successful treatment with doxycycline. This case highlights the importance of considering rare imported infections, like scrub typhus, in travelers returning from endemic areas, especially when an eschar is present.
Key note: Travel history and careful physical examination for an eschar are crucial for diagnosing imported scrub typhus.