An unusual case of typhus group rickettsial infection presenting as cerebrovascular stroke

Rickettsial diseases are a group of infections caused by obligate intracellular Gram-negative bacilli and transmitted to man by arthropod vectors. They are prevalent in many parts in India and are characterized by microvasculitis, causing microinfarcts in various organs.¹ Complications of rickettsial infection include pneumonias, renal failures, and neurological involvement. Neurological complications, such as meningitis and meningoencephalitis, are commonly seen.² Other neurological manifestations are infrequent and rickettsial infection presenting as cerebrovascular stroke is extremely rare. Here, we report a child presenting with prolonged fever, maculopapular rash, and acute onset left-sided hemiplegia. Child was toxic, and had dorsal edema and pallor. His investigations revealed microcytic hypochromic anemia and aseptic meningitis. MRI brain showed infarct over right corona radiata, right basal ganglia, right frontal gyri, insular cortex, and right anterior temporal lobe. Weil–Felix test showed rising titers for OX19 suggesting typhus group of rickettsia. Child responded rapidly to doxycycline. This case highlights the possibility of rickettsial infection in cerebrovascular stroke.