Introduction: Patients with scrub typhus usually present with constitutional symptoms and respond to the standard treatment. However, ongoing clinical deterioration warrants consideration for other associated conditions.
Case description: Here, we describe a patient diagnosed with scrub typhus with rare but life-threatening immune dysfunction.
Conclusion: Hemophagocytic lymphohistiocytosis (HLH) syndrome is due to an atypical immune response commonly triggered by infection. An alarm should be raised, and HLH should be considered in patients with scrub typhus who are nonresponsive to standard treatment. Quick and timely treatment had shown to have a better outcome. Hence physicians should be aware of this rare association and its management for better patient outcomes.