Scrub typhus, an acute febrile illness, is a re-emerging   endemic zoonosis in the Indian subcontinent in the post Covid era with considerable morbidity & mortality; however, it is rarely reported in pregnant women. In this case a 19-year-old primigravida mother at 15th week of pregnancy presented six months back with high grade fever and shortness of breath for five days. Chest X ray showed left lower lobe infection with raised CRP & elevated liver enzymes. After evaluating possible differentials, finally scrub typhus serology (IgM antibody) was detected positive. Timely intervention with Azithromycin saved both the mother and fetus with no anomaly detected till date. This case of scrub typhus was unique in terms of involvement in pregnancy, absence of eschar, lymphadenopathy, headache, skin rash and negative ANA. As the clinical features of scrub typhus are nonspecific and closely mimic other tropical infections, its diagnosis is often delayed or missed particularly in pregnancy. So high grade of clinical suspicion & awareness is needed among gynaecologists in acute febrile illness cases in developing countries especially in unusual presentations for timely diagnosis & management of this deadly disease in pregnancy.

Key Words: Scrub typhus, Pregnancy, HELLP

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