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Scrub typhus is a bacterial infection caused by the Orientia tsutsugamushi bacteria. The illness can cause anything from a fever to serious multi-organ malfunction. Clinical symptoms and antibody serological testing, which have low sensitivity and specificity, are used to make the diagnosis. Multiple organ dysfunction syndrome (MODS) and hemophagocytic lymphohistiocytosis (HLH) are only infrequently linked to scrub typhus. In this study, we describe a 62 year old female who had a prolonged fever without eschar. Following the negative results of normal tests, she was identified as having scrub typhus. After receiving dexamethasone, enhanced life support, and anti-rickettsial medication, the patient, who had progressed to HLH and MODS, made a successful Furthermore, we provide a brief review of the literature on scrub typhus and its complicationsrecovery. Furthermore, we provide a brief review of the literature on scrub typhus and its complications. Introduction Thebacteria Orientia tsutsugamushi causes the natural foci illness scrub typhus. The illness can cause anything from a minor fever to many system dysfunctions. The most pathognomonic symptom is an eschar. Despite their poor sensitivity and specificity, clinical symptoms and serological tests (such as the Weil-Felix test) are employed to diagnose scrub typhus. Alternative testing include enzyme-linked immunosorbent assays (ELISA), polymerase chain reactions (PCR), serum immunoglobulinM (IgM) and immunoglobulinG (IgG) antibodies. mNGS, or metagenomic next generation sequencing, is a cutting-edge approach for locating unique pathogenic diseases. Scrub typhus cases have only seldom been confirmed by mNGS up to this point. Scrub typhus cases have been recorded more frequently in recent years. Multiple organ dysfunction syndrome (MODS) and haemophagocytic lymphohistiocytosis (HLH) linked with scrub typhus have only been described in a small number of investigations. In the rare and fatal hyperinflammatory disease known as HLH, T lymphocytes and macrophages are overactive, while natural killer (NK) cells and cytotoxic T lymphocytes are depleted. This leads to various organ dysfunction caused by cytokine-mediated multiple histiocytic phagocytosis of blood cells. Genetic mutations are the root cause of primary HLH. Immunodeficiency, autoimmune disorders, infections, and malignancies are the primary causes of secondary HLH. In this case report, scrub typhus without eschar was determined by immunoglobulins . The patient developed HLH and MODS but showed clinical improvement. We also analysed the clinical characteristics, diagnostic approaches, therapeutic approaches, and clinical results of scrub typhus and associated HLH.