This paper reports the first case of tsutsugamushi disease (scrub typhus) occurred in Okayama prefecture. The present case was characterized by : 1) arthralgia, conjunctivitis, cough, headache and intermittent fever with malaise, 2) an ulcer (10×7 mm) covered with reddish black eschar, which developed at the inoculation site on the middle of the anterior border of the left axilla, and swelling of the lymphnodes, 3) rash on the whole body, which blanched on pressure, and 4) a positive reaction to the test for C-reactive protein (CRP). Administration of piperacillin (1 g/day, for 2 days) was not effective at all, but that of minocycline (200 mg/day, for 1 day, followed by 100 mg/day, for 7 days) was so effective that body temperature rapidly fell to normal within a day. The general condition improved promptly. The indirect immunoperoxidase reaction showed a high titer of serum antibody for the Karp type of Rickettsia tsutsugamushi. Since Rickettsia tsutsugamushi is distributed widely in Japan, including Okayama prefecture, the physician should take tsutsugamushi disease into consideration when diagnosing acute feverish illnesses.