A novel case of rickettsial encephalitis presenting as isolated global aphasia

This case report details a novel presentation of rickettsial encephalitis in a 25-year-old male patient who arrived with a 4-day history of fever and altered sensorium, marked by no verbal output and a loss of social inhibitions. Clinical examination revealed a 2x2 cm eschar on the right leg, moderate splenomegaly, thrombocytopenia, and leucopenia. An MRI of the brain showed focal T2/FLAIR hyperintensity involving the splenium of the corpus callosum, suggestive of cytotoxic lesions of the corpus callosum (CLOCCs). Despite the lack of structural abnormalities in primary language areas, the patient exhibited global aphasia. A positive Weil-Felix test indicated rickettsial infection. The patient was treated with ceftriaxone and doxycycline, leading to gradual neurological improvement and complete recovery within 15 days. This case highlights the importance of high clinical suspicion for rickettsial encephalitis, timely diagnosis, and appropriate antimicrobial therapy to achieve favorable outcomes.