Scrub typhus is an acute febrile illness caused by Orientia tsutsugamushi. The diagnosis of scrub typhus relies on patient’s history of exposure, clinical manifestations, and results of serological tests. Our patient had history of altered sensorium, inability to walk and macular rashes predominantly distributed over the chest and bilateral upper limbs. Post serological testing the patient was referred to radiology department for MRI Brain. Radiologically MRI being a superior modality helps in evaluation of lesions in depth helping to simplify the diagnosis of meningitis, scrub typhus encephalitis and other related conditions. There are various described findings in scrub typhus encephalitis in MR brain imaging and our case shows an unusual finding in brain imaging.

Keymessage: In patients presenting with features of meningoencephalitis/encephalopathy, along with MRI brain showing micro-hemorrhages and white matter abnormalities, scrub typhus should always be ruled out as prompt administration of antibiotics is the only known management to cure scrub typhus.

Keywords: MRI, Weil Felix test, Direct immunofluorescence assay, Meningoencephalitis, Scrub typhus