Rickettsial Encephalitis Presenting as Status Epilepticus in a 30-year-old Male: A Diagnostic Challenge

Rickettsial encephalitis is a rare and underdiagnosed form of central nervous system infection, often mimicking viral, autoimmune, or idiopathic encephalitides. Its diagnosis is particularly difficult in the acute phase due to nonspecific presentation and low initial sensitivity of conventional laboratory tests. A 30-year-old male presented with high-grade fever, vomiting, and new-onset generalized tonic-clonic seizures. Initial imaging, cerebrospinal fluid (CSF) analysis, and viral panels were inconclusive. He experienced recurrent seizures and deteriorated neurologically, requiring mechanical ventilation. Despite negative CSF polymerase chain reaction panels (including herpes simplex virus and other viruses), magnetic resonance imaging brain showed changes suggestive of encephalitis. After extensive evaluation, including negative autoimmune and viral panels, a positive Weil-Felix test and characteristic rash led to a diagnosis of rickettsial encephalitis. The patient responded to doxycycline and azithromycin and was eventually extubated and discharged in a conscious and oriented state. Rickettsial encephalitis should be included in the differential diagnosis for acute meningoencephalitis with seizures, particularly in endemic regions. Early empirical doxycycline can be lifesaving. A high index of suspicion and thorough evaluation are essential in such atypical presentations.