Abstract: A 41yearold male patient presented with persistent fever and right forearm eschar after hiking with poor response to a variety of broad spectrum antibiotics, followed by thrombocytopenia, elevated transaminase and bilirubin, oliguria, and chest distress, received continuous renal replacement therapy. The gene sequence of orientia tsutsugamushi was detected by metagenomic nextgeneration sequencing in the blood of the patient and confirm the diagnosis of scrub typhus.After doxycycline treatment, the temperature was normal, platelets increased, transaminase and bilirubin decreased, and renal function recovered to normal.