Scrub typhus is an acute febrile illness caused by the bacterium Orientia tsutsugamushi. It usually presents with high-grade fever, body aches, and skin rash. We report the case of a woman who presented with acute febrile illness, bilateral pneumonia, and severe hypoxemia. The presence of a typical eschar on the abdomen, made us suspect scrub typhus. Anti-O. tsutsugamushi Immunoglobulin M (IgM) antibody in the serum was detected in significant titers. She was treated with intravenous doxycycline and supplemental oxygen. Thus, scrub typhus should be considered in the differential diagnosis of febrile illness with acute respiratory distress syndrome.