Acute pancreatitis due to scrub typhus.

[scrub typhus]

Scrub typhus is endemic in large parts of India and can cause multi-organ failure and death . Acute pancreatitis as a complication is very rare and is potentially fatal . This case series describes seven adult patients who presented with an acute febrile illness and were diagnosed to have scrub typhus with acute pancreatitis . The mean age of the seven patients with acute pancreatitis was 49 .4 years , and mean duration of fever prior to presentation was 7 .7 days . All seven patients had abdominal pain , and three had a pathognomonic eschar . The mean serum lipase level was 1 ,509 U /L (normal value : <190 U /L ) and the mean serum amylase level was 434 U /L (normal value : <200 U /L ). Six patients had evidence of multi-organ dysfunction . Hematological and respiratory system dysfunction was seen in five patients , hepatic and renal dysfunction in four , and central nervous system dysfunction in three patients . Three patients who had ≥4 organs involved , died (mortality rate : 42 .8 %). Our case series shows that pancreatitis in scrub typhus is an extremely rare complication and when present , is associated with increased mortality (42 .8 %). Physicians may be familiar with the various complications of scrub typhus but less so with acute pancreatitis and hence may be underdiagnosed .