Background: Scrub typhus is known to cause meningitis in children. Literature on neuroimaging findings in scrub typhus is very scarce. Case characteristics: A case of acute meningoencephalitis with raised intracranial tension demonstrated basal meningeal enhancement and ventricular prominence on CECT brain. In view of clinical nonresponsive and CECT findings, antitubercular therapy was started. Subsequently rickettsial serology came out to be positive for Orientia tsutsugamushi; good response was observed to doxycycline. Outcome: Dramatic clinical response to doxycycline was observed favoring a diagnosis of scrub typhus meningitis.

Keywords: Scrub typhus; Tuberculous meningitis; Basal meningeal enhancement.