Perieschar Nodule: An Unusual Late Sequela of Scrub Typhus

Abstract

This case report describes a rare late presentation of a peri-eschar nodule at the site of a previous scrub typhus eschar in a 40-year-old male. The report highlights the importance of considering a remote history of eschar in patients presenting with unusual cutaneous nodules, as these may represent long-term immune responses or incomplete resolution of the original inflammation. While most cases of scrub typhus heal spontaneously, peri-eschar nodules are a rare complication that can mimic neoplastic or inflammatory lesions. Histopathological examination revealed chronic inflammation with fibrosis and macrophage infiltration, supporting the diagnosis. Immunohistochemistry for *Orientia tsutsugamushi* was not performed due to its non-availability and the chronic nature of the lesion. The prolonged latency period of 10 years is unusual and makes a direct causal relationship difficult to establish. However, it is possible that chronic localized immune dysregulation or subclinical residual inflammation at the eschar site contributed to delayed lesion development. Surgical excision remains the primary treatment modality, and doxycycline may be considered if residual infection is suspected. This case emphasizes the importance of including prior scrub typhus infection in the differential diagnosis of atypical cutaneous nodules and underscores the need for early diagnosis and excisional biopsy to rule out infection or neoplasia.