We describe a 64-year-old man with scrub typhus who presented with both polyneuropathy and cerebral infarction. A neurological examination revealed a confused mental state, stiff neck, hearing impairment, symmetric weakness, sensory loss, and ataxia. Electrophysiologic studies showed demyelinating sensorimotor polyneuropathy and sensorineural hearing loss. Brain magnetic resonance imaging showed multiple infarctions. Brain involvement or polyneuropathy associated with scrub typhus has been rarely reported, and the pathogenic mechanism underlying the multiple neurological complications remains to be elucidated. Scrub typhus is a febrile illness caused by Orientia tsutsugamushi, and is characterized by fever, rash, eschar, myocarditis, and pneumonitis. Neurological involvement usually includes meningitis and hearing loss, possibly due to involvement of the eighth cranial nerve.1,2 However, involvement of the brain parenchyma and peripheral nerve is rarely reported. 3-5 Here we report a case of scrub typhus with cerebral infarction and polyneuropathy. CASE REPORTA 64-year-old man was admitted due to fever, myalgia, dysarthria, dizziness, and headache that had first appeared several days previously. He had worked at a sewage disposal plant in the northern rural area of Seoul. He had suffered from mild conductive hearing impairment of undetermined cause in the left ear for several years. On admission, his body temperature was 39℃ and his blood pressure was normal (110/70 mmHg). Eschar was not evident. A neurological examination revealed a confused mental state and neck stiffness. Limb weakness was absent, but he exhibited multidirectional sway on tandem gait.Laboratory tests showed leukocytosis (14.9×10 3 cells/μl) and thrombocytopenia (33×10 3 platelets/μl).Liver enzymes were elevated (aspartate aminotransferase = 214 IU/l, alanine aminotransferase = 151 IU/l) and renal function was impaired (blood urea nitrogen = 31creatinine = 1.6 mg/dl). Initial computed tomography (CT) of the brain was normal. (Fig. A), a chest radiograph indicated pulmonary edema, electrocardiography showed sinus tachycardia, and an echocardiogram was normal. Cerebrospinal fluid (CSF) was not examined due to the presence of thrombocytopenia. The patient was initially positive for serum indirect immunofluorescent antibody against O. tsutsugamushi (1:800),