Rickettsial Encephalitis Presenting as Status Epilepticus in a 30-year-old Male: A Diagnostic Challenge.
Pradnya Muntode, Chandan Kumar Dash, J S Dhadwad et al.
✦ AI-curated · Sources linked
Case in brief
A 30-year-old man presented with high fever, vomiting, and new-onset generalized tonic-clonic seizures. Initial imaging, cerebrospinal fluid analysis, and viral testing were inconclusive. Recurrent seizures and neurological deterioration led to mechanical ventilation; brain MRI showed changes suggestive of encephalitis, while CSF PCR and autoimmune and viral panels were negative. A positive Weil-Felix test together with a characteristic rash supported the diagnosis of rickettsial encephalitis. He improved with doxycycline and azithromycin, was extubated, and was discharged conscious and oriented.
What made this case unusual
Status epilepticus and severe neurological deterioration occurred despite inconclusive initial investigations; the diagnosis was supported by the combination of a characteristic rash and positive Weil-Felix test after negative CSF viral PCR and autoimmune and viral panels.
Diagnostic / clinical pearl
In acute meningoencephalitis with seizures, negative initial CSF and viral studies do not exclude rickettsial encephalitis; consider it particularly in endemic regions when a characteristic rash is present.