{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:34:46Z","timestamp":1766399686151,"version":"3.48.0"},"reference-count":17,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T00:00:00Z","timestamp":1764806400000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Scrub typhus, caused by\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Orientia tsutsugamushi<\/jats:italic>\n                    <\/jats:styled-content>\n                    , is an acute febrile illness prevalent in Nepal with a wide spectrum of clinical presentations. Severe forms can lead to multiorgan dysfunction, including acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), septic shock, and rarely, acalculous cholecystitis. We report a case of a previously healthy 30\u2010year\u2010old female from Nepal presenting with fever, jaundice, and epigastric pain. Clinical evaluation revealed hemodynamic instability, respiratory distress, and an eschar on the lower extremity. Laboratory and imaging workup showed AKI, elevated liver enzymes, positive IgM and IgG for\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>O. tsutsugamushi<\/jats:italic>\n                    <\/jats:styled-content>\n                    , gallbladder wall thickening without stones, and chest radiograph findings consistent with ARDS. She was diagnosed with scrub typhus complicated by AKI, ARDS, septic shock, and acute acalculous cholecystitis. The patient was treated promptly with doxycycline and supportive intensive care, including oxygen therapy, intravenous fluids, and antibiotics. Clinical and laboratory improvement ensued, and she was discharged in stable condition after 2\u2009weeks of hospitalization. This case highlights the potential for severe multisystem complications of scrub typhus, including the rare occurrence of acalculous cholecystitis secondary to systemic vasculitis and shock. Early recognition and timely management in endemic regions are critical to improving outcomes.\n                  <\/jats:p>","DOI":"10.1002\/ccr3.71632","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T03:50:32Z","timestamp":1764906632000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rare and Severe Multisystem Cascade of\n                    <scp>AKI<\/scp>\n                    ,\n                    <scp>ARDS<\/scp>\n                    , and Septic Shock Leading to Acalculous Cholecystitis in a Young Scrub Typhus Patient: A Case Report From Nepal"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4834-9354","authenticated-orcid":false,"given":"Prabhat","family":"Kaphle","sequence":"first","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7082-0235","authenticated-orcid":false,"given":"Maya","family":"Upadhyaya","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarjan","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Surkhet Provincial Hospital  Surkhet Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amrita","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Bhojpur District Hospital  Bhojpur Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9542-9964","authenticated-orcid":false,"given":"Dhanlaxmi","family":"Giri","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5292-2087","authenticated-orcid":false,"given":"Kamal","family":"Hamal","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2932-3008","authenticated-orcid":false,"given":"Liladhar","family":"Ojha","sequence":"additional","affiliation":[{"name":"National Health Action Force Nepal  Dhading Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,4]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7505108"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006062"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010019\u20102675\u20103"},{"volume-title":"StatPearls","year":"2025","author":"Jones M. W.","key":"e_1_2_13_5_1"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000362444"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed6040208"},{"key":"e_1_2_13_8_1","unstructured":"CARE \u201cCARE Case Report Guidelines \u201d2013 CARE Checklist https:\/\/www.care\u2010statement.org\/checklist."},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2015.30.11.1698"},{"key":"e_1_2_13_10_1","first-page":"143","article-title":"Acute Cholecystitis as an Unusual Presentation of Scrub Typhus: A Report of Two Cases and Review of the Literature","volume":"48","author":"Charoenphak S.","year":"2017","journal-title":"Southeast Asian Journal of Tropical Medicine and Public Health"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002605"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijn.IJN_133_17"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/00313020801911488"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2012.12.023"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.188206"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i36.5138"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.5492\/wjccm.v4.i3.244"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.138137"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.71632","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T10:31:23Z","timestamp":1766399483000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.71632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":17,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1002\/ccr3.71632"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.71632","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"type":"print","value":"2050-0904"},{"type":"electronic","value":"2050-0904"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-08-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71632"}}