Last reviewed: October 2023
Author: Mohd Waffy Zahiruddin bin Saparudin, Medical Officer, Emergency and Traumatology Department Hospital Sarikei, Malaysia
Reviewing dermatologist: Dr Ian Coulson (2023).
Edited by the DermNet content department
A 43-year-old female with no known prior medical illnesses presented with lethargy, headache, fevers, and myalgia of one week duration. She also reported an itchy left thigh lesion and was unaware of any insect bites. However, she had been to the woods to find firewood in a Sarawak rainforest about one week prior to the onset of the lesion.
The image is typical of the skin lesions seen in scrub typhus; note the eschar formation with an erythematous periphery, coupled with the history of malaise and myalgia, and the geographical location It is caused by bites of the trombiculid mite larvae (chiggers) which are infected with the bacteria Orientia tsutsugamushi.
Scrub typhus should be treated with doxycycline; azithromycin is an alternative.
For more information, see Scrub typhus.
