eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2023-01-12 11 1 10 13 10.12691/ajmcr-11-1-3 AJMCR20231113 article Youichi Yanagawa yyanaga@juntendo.ac.jp 1 Ken-ichi Muramatsu 1 Yoichiro Maekawa 1 Soichiro Ota 1 Ikuto Takeuchi 1 Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University An 81-year-old man was found unconscious in a bathtub by his wife after having taken a long bath. He was rescued by his wife and son, and they dressed him while calling for an ambulance. On arrival, he was in a shock state with convulsion. After exposing him, he was found to have multiple macular skin rashes with eschar with a red halo on his lower right abdomen. He was treated with anticonvulsant and massive infusion. He had had right lower abdominal skin lesions for more than two weeks, general fatigue and skin rash for one week, and a fever for four days before the arrival. A biochemical analysis of his blood on arrival indicated inflammation, hepatic, renal disturbance, and coagulopathy. As he had the triad of tick-mediated infectious diseases, he received minocycline. His general condition improved, and he regained his consciousness on day 6. On day 9, we obtained positive results for scrub typhus. Finally, he was discharged home. Physicians should perform a full body skin examination of patients with a coma or fever in order not to miss fatal diseases. http://pubs.sciepub.com/ajmcr/11/1/3/ajmcr-11-1-3.pdf scrub typhus full body skin examination eschar with red halo