Background: Scrub typhus, a zoonotic illness caused by Orientia tsutsugamushi, is a significant cause of acute undifferentiated febrile illness in endemic regions. While hepatosplenomegaly is a common feature, massive splenomegaly and gastrointestinal ulceration are rare. Case Presentation: We report the case of a young adult male who presented with highgrade fever, jaundice, abdominal pain, hypotension and melena. Examination revealed massive splenomegaly and hepatomegaly. Laboratory findings showed cytopenias, liver dysfunction and acute kidney injury. Imaging confirmed massive splenomegaly, and upper gastrointestinal endoscopy revealed gastric and duodenal ulcers. Extensive workup for common causes of massive splenomegaly, including malaria and leishmaniasis, was negative. Serology for scrub typhus came out positive. The patient was started on doxycycline, resulting in rapid clinical improvement, resolution of organ dysfunction and normalization of spleen size. Conclusion: Scrub typhus should be considered in the differential diagnosis of fever with massive splenomegaly, especially in endemic areas. When encountering massive splenomegaly, thorough investigation is imperative to determine its cause. Before resorting to invasive procedures, it's crucial to rule out infectious causes. Scrub typhus, for instance, can manifest as fever with reversible massive splenomegaly upon appropriate therapy.