IFA was considered as the gold standard diagnostic test instead of IgM ELISA.[20] mNGS performed better than conventional clinical methods to early diagnose scrub typhus.[21] In this case, Weil-Felix test was performed twice without IgM ELISA or IgM IFA, and the patient refused mNGS due to high cost. The gene discussed is CD40LG; the disease is scrub typhus.