Description

A 49-year-old male presented to the emergency department with fever, abdominal pain, icterus, and acute kidney injury requiring hemodialysis. Laboratory investigations revealed thrombocytopenia, hyponatremia, evidence of liver injury, and positive IgM serology for Scrub typhus. Upon examination, an eschar was identified in his right groin. The patient responded well to doxycycline and became dialysis-independent within two weeks, with his renal function returning to baseline by one-month post-treatment.

Conditions to consider in the differential diagnosis of fever accompanied by acute hepato-renal involvement include bacterial sepsis, viral hepatitis, malaria, HIV, leptospirosis, scrub typhus, and dengue fever [1,2]. Additionally, drug-induced nephro or hepato-toxicity should be considered.

Figure 1: Clinical image.

References

1. Minemura M, Tajiri K, Shimizu Y. Liver involvement in systemic infection. World J Hepatol. 2014; 6(9): 632-42. doi: 10.4254/wjh.v6.i9.632.
2. Prasad N, Patel MR. Infection-Induced Kidney Diseases. Front Med (Lausanne). 2018; 5: 327. doi: 10.3389/fmed.2018.00327.