INTRODUCTION
The average life span of red blood cells is 120 days, and hemolysis is a
state of premature destruction of red blood cells. When bone marrow
cannot compensate for the ongoing loss of red blood cells, anemia
develops. Hemolysis can be intravascular or extravascular. Among
numerous causes of intravascular hemolytic anemia, commoner ones are
malaria, autoimmune hemolysis, G6PD deficiency, and RBC membrane
defects. Glucose-6-phosphate dehydrogenase is a housekeeping enzyme that
plays a vital role in the prevention of cellular damage from reactive
oxygen species.1 G6PD deficiency is an X-linked
disorder, and its estimated global prevalence is
4.9%.2 Usually the enzyme deficient is asymptomatic
until presenting with an acute episode of intravascular hemolysis after
being triggered by an oxidant stress. An oxidant stress could be due to
an infection, consumption of certain group of drugs, or fava
beans.3
Scrub typhus is a tropical disease, caused by Orientia
tsutsugamushi , a gram-negative bacillus and an obligate intracellular
parasite belonging to the family Rickettsiaceae. It is transmitted due
to bites of infected chiggers (larva form of trombiculid mites). Mostly
scrub typhus infection presents with flu-like symptoms (fever, headache,
myalgia, etc.), and sometimes severe infection can lead to pneumonia,
acute respiratory failure, shock, meningoencephalitis, and
DIC.4 During an episode of hemolysis, identifying the
underlying cause is crucial, as controlling the precipitating factor is
essential for effective management of the current episode and to
consider prophylaxis for the future episodes. Also, understanding
potential triggers may shorten hospital stays and reduce healthcare
costs. Here, we report a case of scrub typhus infection presenting with
extensive intravascular hemolytic anemia, which was later diagnosed as
mild G6PD deficiency.