Abstract: Objective To report a clinically confirmed case of multiple organ dysfunction caused by delayed treatment of severe tsutsugamushi disease, in order to improve clinicians understanding of the disease. Methods The clinical and laboratory data of the patient were analyzed, relevant literature was reviewed, and the diagnosis and treatment were summarized. Results The patient, a 47-year-old male, was admitted due to symptoms including repeated chest tightness for half a month, fever and disturbance of consciousness for 2 days. Physical examination showed red macules and papules all over the body, and an eschar at the scrotum. Metagenomic next-generation sequencing(mNGS)suggested Orientia tsutsugamushi. After doxycycline and supportive therapy, the percentage of white blood cells and neutrophils increased day by day; oxygenation index continued to decrease; coagulation dysfunction occurred; heart, liver and kidney failed; the condition continued to deteriorate and the patient eventually died. Conclusion The key to the prognosis of tsutsugamushi disease is early diagnosis and reasonable treatment, which generally lead to good prognosis. Delay diagnosis and treatment can aggravate organ damage and increase the risk of death.

Key words: Orientia tsutsugamushi, Multiple organ dysfunction, Metagenomic next-generation sequencing