A Case Report

Abstract

Abstract Acute respiratory distress syndrome (ARDS) became synonymous with COVID-19 infection during the recent pandemic. We report this case who presented with fever and ARDS and had bilateral pneumonia on chest x-ray. After hospitalization, he deteriorated and required invasive ventilatory support. His real-time reverse transcription–polymerase chain reaction for COVID 19 was twice negative. Hence, he was screened for other infections causing ARDS. He had no eschar clinically but had other clues, such as leucocytosis, transaminitis, hypoalbuminemia, and thrombocytopenia. On investigations, his serology for scrub typhus was positive. He was given doxycycline to which he responded dramatically and was weaned off ventilator. If real-time reverse transcription–polymerase chain reaction for COVID-19 infection is negative, other rare but treatable respiratory infections leading to ARDS should be considered.