<p><b><span style="color:#004E70"></span></b></p><p><b><span style="color:#004E70">Background:</span></b> Scrub typhus is a mite-transmitted zoonosis caused by Orientia tsutsugamushi that classically presents with fever, an inoculation eschar, and a truncal maculopapular rash. Cutaneous small-vessel vasculitis is a rare and often overlooked manifestation that can precede or substitute for the classic exanthem. </p><p><b><span style="color:#004E70">Case report:</span></b> A 55-year-old female daily-wage labourer presented with a two-week history of neck pain and giddiness, preceded by a partially treated febrile illness. Initial examination showed no eschar or rash and routine investigations revealed only a raised erythrocyte sedimentation rate and mild transaminitis. On the second hospital day she developed high-grade fever with conjunctival injection, followed by an itchy, discrete-to-confluent maculopapular rash concentrated over the palms and soles. Serology (ELISA) was positive for scrub typhus IgM, while dengue, leptospirosis, HIV, and viral hepatitis panels were negative and blood cultures were sterile. A skin punch biopsy demonstrated perivascular neutrophilic infiltration, endothelial swelling, nuclear dust, and fibrinoid necrosis, confirming leukocytoclastic vasculitis. The patient improved rapidly on oral doxycycline with resolution of fever by day five and was discharged in stable condition. </p><p><b><span style="color:#004E70">Conclusions:</span></b> Leukocytoclastic vasculitis with an acral, palmoplantar-predominant rash is an unusual initial cutaneous manifestation of scrub typhus. In endemic regions, this diagnosis should be considered in patients presenting with unexplained fever and vasculitic rash even in the absence of a classic eschar, given the prompt and often diagnostic response to doxycycline.</p>
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Introduction: Cervical cancer remains a significant public health burden in Indonesia; one of the primary reasons is low screening rates. Due to the importance of screening to prevent progression of cervical pre-cancer, it is important to understand the implementation barriers or challenges to screening and explore strategies or interventions that can address these barriers. Method: A narrative review of articles was conducted. Databases searched for articles included PubMed, Scopus, ScienceDirect, Garuda, Neliti, and Google Scholar. Inclusion criteria were that studies must discuss topics related to barriers to cervical cancer screening in Indonesia and strategies to address these barriers, be published in the last ten years, and be published in English or Bahasa Indonesia. Result: Primary barriers: (1) individual and psychosocial; (2) socio-cultural; and (3) health system and logistical. Key strategies: (1) leveraging HPV self-sampling; (2) leveraging existing technological infrastructure; and (3) empowering a network of community health workers and digital health platforms. Conclusion: This review highlights the need of integrated system with sustained political will and collaboration to ensure this comprehensive strategy, from technology-enabled screening to systematic and accessible treatment pathways, is implemented effectively, equitably, and successfully.