Neurorickettsioses: a rare presentation with stroke in a young adult

Acute stroke-like presentations due to rickettsial infections have been sparsely reported in literature. We report a young patient who presented with high grade fever and acute encephalopathy with right hemiplegia. CT head showed left cerebral, bilateral thalamic and midbrain infarcts. The stroke in young work-up for conventional and non-conventional risk factors including few infections known to cause cerebral vasculitis was negative. He did not respond to empirical antimalarials and antibiotics. With a high index of suspicion of his 'febrile cerebrovasculitis' like presentation, serological test for rickettsia was done and found to be positive. He responded to doxycycline. This case expands the spectrum of presentation of neurorickettsioses and highlights the importance of considering rickettsial vasculitis as one of the potentially treatable causes of infections causing stroke.