Suspected Murine Typhus Associated With Neurologic Symptoms and Posterior Reversible Encephalopathy Syndrome (PRES)-Like MRI Abnormalities: A Case Report
Abstract
Murine typhus, caused by Rickettsia typhi, is a flea-borne zoonosis that typically presents with fever, headache, myalgias, and rash. Central nervous system involvement is uncommon, and neuroimaging findings that mimic posterior reversible encephalopathy syndrome (PRES) are rarely reported. This case highlights a rare neuroinfectious presentation of murine typhus with PRES-like imaging findings in a young woman. A previously healthy woman in her 30s presented with persistent retro-orbital headaches, intermittent fevers, tremors, dysarthria, photophobia, myalgias, progressive weakness, and recurrent syncopal episodes. Initial computed tomography of the head demonstrated age-advanced microvascular ischemic changes versus possible PRES. Brain magnetic resonance imaging later revealed bilateral parietal-predominant fluid-attenuated inversion recovery (FLAIR) hyperintensities in the white matter, concerning for PRES. Cerebrospinal fluid (CSF) analysis was unremarkable, and extensive infectious and autoimmune evaluation was unrevealing. Despite nondiagnostic testing, persistent fevers and neurologic symptoms prompted empiric doxycycline therapy for suspected atypical infection. Within 48 hours, the patient experienced marked clinical improvement with resolution of fever, dysarthria, tremors, photophobia, and severe headache. Post-discharge serology showed a positive Rickettsia typhi IgM with a negative IgG. While these findings were consistent with possible early murine typhus,…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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