Case ReportA Case Report Acute Respiratory Distress Syndrome—If Not COVID, What Else?Khot, Rajashree MD, DNB; Jafri, Shahnawaz MD; Rathod, Bharatsing MD; Joshi, Prashant P. MD Author Information From the Department of General Medicine, All India Institute of Medical Sciences, Nagpur, India. Correspondence to: Rajashree Khot, MD, DNB, Plot No 52 Jayneeta, New Ramdaspeth, Nagpur 440010, Maharashtra, India. E-mail: [email protected]. The authors have no funding or conflicts of interest to disclose. R.K. conceptualized, supervised the investigations and management, and prepared the manuscript. S.J. identified, investigated, and managed the case. B.R. was responsible for the successful ventilatory management of the patient and gave valuable inputs in the discussion part of manuscript. P.P.J. suggested corrections and approved the final version of the manuscript. Informed consent was obtained from the patient himself. Data Availability: Available in the medical record section of the Institute and copy available with the corresponding author, R.K. Infectious Diseases in Clinical Practice 31(2):e1237, March 2023. | DOI: 10.1097/IPC.0000000000001237 Buy Metrics Abstract Acute respiratory distress syndrome (ARDS) became synonymous with COVID-19 infection during the recent pandemic. We report this case who presented with fever and ARDS and had bilateral pneumonia on chest x-ray. After hospitalization, he deteriorated and required invasive ventilatory support. His real-time reverse transcription–polymerase chain reaction for COVID 19 was twice negative. Hence, he was screened for other infections causing ARDS. He had no eschar clinically but had other clues, such as leucocytosis, transaminitis, hypoalbuminemia, and thrombocytopenia. On investigations, his serology for scrub typhus was positive. He was given doxycycline to which he responded dramatically and was weaned off ventilator. If real-time reverse transcription–polymerase chain reaction for COVID-19 infection is negative, other rare but treatable respiratory infections leading to ARDS should be considered. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.