Abstract / Summary
Abstract Background: Scrub typhus causes 25–30% of undifferentiated acute febrile illness in South India and can mimic acute abdomen. Case Report:A 7-year-old boy presented with five-day fever, right iliac fossa pain, peritoneal signs and hypoxia (SpO₂ 88%). Examination revealed perineal eschar. Ultrasound showed compressible 8.24 mm appendix without inflammatory changes. Because fever preceding pain and sonographic findings were atypical for appendicitis, appendicitis was considered unlikely. Empirical intravenous doxycycline and azithromycin were initiated. Defervescence occurred within 48 hours, and IgM ELISA confirmed scrub typhus. The presence of the eschar prevented unnecessary diagnostic laparoscopy.
Conclusion: In endemic regions, peritoneal signs with systemic features do not always indicate surgical disease, but appendicectomy remains necessary when appendicitis cannot be excluded. Systematic examination for concealed eschar and careful ultrasound interpretation are critical, though eschar is absent in 50–60% of paediatric cases.