Scrub typhus is not one of the more commonly encountered diseases in travelers returning from Asia, but it deserves more consideration in view of its severity and the availability of specific chemotherapy and chemoprophylaxis. We describe a case of scrub typhus that was associated with coma and multiorgan failure in a traveler returning to the United States from Thailand. The diagnosis was made only retrospectively despite a travel history and clinical signs that suggested infection with Rickettsia tsutsugamushi. No specific therapy was given, and marked neurological impairment persisted 6 months after the beginning of the illness. An increased awareness of scrub typhus is a prerequisite for recommending prophylaxis and instituting prompt therapy.