To improve the understanding of upper gastrointestinal bleeding (UGB), multiple organ function injury (MOD) and multiple organ failure syndrome (MOFS) caused by tsutsugamushi disease (TD).

The treatment process of UGB, MOD and MOFS of a 58-year-old male patient with TD was analyzed.

The patient was hospitalized with fever for four days and rash for two days. He had a history of field trip. There was 1.5 cm × 1.5 cm eschar on left leg for physical examination, crater like scaling around, left inguinal lymph node enlargement. Laboratory examination showed that alanine aminotransferase (ALT), aspartate amino transferase (AST), gomerular filtration rate (GFR), blood urea nitrogen (BUN), serum creatinine (Scr), hydroxybutyrate dehydrogenase (HBDH), creatine kinase isoenzyme (CKim), lactate dehydrogenase (LDH), high-sensitivity CRP (hsCRP) and procalcitonin (PCT) increased significantly, and eosinophils (EOS) decreased to 0. TD with MOD was diagnosed according to the tsutsugamushi integral diagnosis scale, the positive results of Rickettsia tsutsutsugamushi antibody and antigen. On the third day of admission, this patient had repeated UGB, MOFS (shock, respiratory failure), platelet (PLT) decreased rapidly, and ALT, AST, BUN, Scr, HBDH, CKim, LDH, hCRP and PCT furtherly increased. Laboratory examination showed dysfunction of blood coagulation. The clinical diagnosis was TD with MOF (circulatory failure, respiratory failure), mod (liver, kidney and blood system), sepsis. Under the assistance of endotracheal intubation, respiration, anti-shock and organ protection, the upper abdominal multi-slice spiral computed tomography and digital subtraction angiography examination determined that the left gastric artery branch was bleeding, and the bleeding vessels were embolized to stop bleeding. Gastroscopy in convalescence revealed hemorrhagic ulcer and histopathology showed inflammatory reaction. This is the first report of UGB, MOFS, mod and sepsis caused by TD at domestic and overseas.

TD could cause hemorrhagic ulcer and lead to UGB and MOFS. On the basis of etiological treatment, interventional treatment for bleeding is the key to successful rescue.