We first report a case that demonstrates superi-mposed acute renal failure associated with rhabdo-myolysis in a patient with tsutsugamushi disease. The clinical presentation was that of insidious onset of fever, abdominal pain, back pain, renal failure and respiratory failure over about 20 days period. The renal function was progressively deteriorated and the serum creatinine concentration increased from 1.4 to 8.4mg/dL, while the patient was in a state of septic shock caused by tsutsugamushi disease. The laboratory data including increased muscle enzymes such as CK, LDH, SGOT, myoglobin, positive test for urine myoglobin, and increased uptake of bone scan were consistent with rhabdomyolysis. On consideration of the cause of rhabdomyolysis in this patient, endotoxin made in the state of septic shock had triggered a muscle necrosis and acute renal failure aggravated by dehydration and metabolic acidosis. She was recovered by the proper use of a IV doxycycline as the therapy of tsutsugamushi disease with a maintenance of renal blood flow by hydration, mannitol, bicarbonate and protection of hypotension. We suggest that rickettsial disease, especially tsutsugamushi disease can result in the acute renal failure by rhabdomyolysis.