Rare presentation of Typhus Fever with multiorgan failure and Disseminated Intravascular Coagulation

A 46 years old female found to be unconscious at home and brought by neighbours. On admission her GCS was 9. Airway was patent with normal breathing pattern. She tachycardic with low volume pulse and bloodpressure is 60/40mmHg. She was febrile on admission. During resuscitation she received fluid boluses up to 1.5 litres (30ml/kg) .Intravenous noradrenaline was commenced to maintain BP. On examination both lungs breath sounds were equal, vesicular breathing and there were occasional crepitations. There was an eschar on the abdominal wall.