Abstract

Scrub typhus, an acute febrile illness caused by Orientia tsutsugamushi-induced vasculitis, is common in Korea, Asia and Pacific Islands. Endoscopic mucosal lesions or mucosal damages have rarely been reported in Scrub typhus. However, four cases of upper gastrointestinal bleeding, controlled by hemoclipping, in Tsutsugamushi-infected patients have been reported in Korea; although, no case of lower gastrointestinal bleeding in Scrub typhus has been reported. We experienced massive hematochezia in a 77-year-old female patient with Scrub typhus. Special studies, including upper gastroduodenoscopy, colonoscopy, abdominal CT scan, and SMA angiography were performed, but the focus of the bleeding could not be found. An RBC scan showed suspicious small bowel bleeding, but a capsule endoscopy could not reveal the focus of the bleeding focus; however, a colonoscopy showed active bleeding at the terminal ileum, with multiple ileal ulcerations. After conservative therapy, the patient's condition was stable and the hematochezia disappeared.