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.