Case Report: Pediatric Rickettsia felis encephalitis-a rare case and literature review
Abstract
Background: Rickettsia felis (R. felis), an obligate intracellular bacterium, has been reported to cause human encephalitis. Clinical reports of R. felis encephalitis remain rare, particularly in children. Herein, we present a pediatric case and review the relevant literature.
Case report: A previously healthy 9-year-old boy initially presented with fever and headache. Following admission, he developed hyperpyrexia and somnolence. Cranial magnetic resonance imaging revealed a left temporal lobe lesion with ipsilateral temporoparietal meningeal enhancement, and electroencephalography showed background slowing. Metagenomic next-generation sequencing of cerebrospinal fluid detected a high abundance of R. felis sequences, whereas autoantibody testing for central nervous system autoimmune diseases was negative. Based on these findings, a diagnosis of R. felis encephalitis was established. The child fully recovered and was discharged after receiving doxycycline-based antimicrobial therapy combined with glucocorticoids, intravenous immunoglobulin, and intracranial pressure management.
Conclusion: This rare case highlights that R. felis infection should be included in the differential diagnosis of encephalitis. Metagenomic next-generation sequencing is recommended for early etiological diagnosis to facilitate timely and effective clinical intervention.
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