Cardiac injury was commonly seen in patients with O tsutsugamushi infection, presenting as NT pro-BNP, troponin T, and CK-MB levels elevated as well as ejection fraction reduced in echocardiography, and ECG abnormalities.[6,17] Myocardial injury, myocarditis, and left ventricular systolic disfunction were frequently recognized and associated with increased morbidity but not mortality.[18] Due to this phenomenon, AMI as a rare cardiac disease in scrub typhus was easily misdiagnosed. This evidence concerns the gene NPPB and scrub typhus.