A case of neonatal hemophagocytic lymphohistiocytosis associated with scrub typhus

We report a fatal case of neonatal scrub typhus with hemophagocytic lymphohistiocytosis (HLH). Metagenomic next-generation sequencing and maternal serological testing suggested the possibility of transplacental or breast milk transmission. Scrub typhus should be considered in neonates with sepsis-like symptoms or HLH of unknown etiology, particularly in endemic regions.