Rickettsial infection causing non-aneurysmal subarachnoid hemorrhage with transient corpus callosum lesion

Abstract

Rickettsial infection is caused by intracellular gram-negative bacilli, rickettsiae, which are transmitted via arthropod vectors. These stealthy bacteria have evolved sophisticated mechanisms to invade host cells, where they exploit cellular mechanisms for their replication and survival. Rickettsial infection represents a significant public health concern due to the ability of rickettsiae to infect a wide range of organs, including the central nervous system. In this case report, a 23-year-old male presented with a severe headache and flu-like symptoms. The discovery of hemorrhagic cerebrospinal fluid retrieved from a lumbar puncture raised concerns about its potential neurological involvement. Subsequent magnetic resonance imaging for the brain revealed a transient lesion in the splenium of the corpus callosum, a rare finding that can be associated with various brain etiologies, including infection. Given the clinical presentation and imaging findings, serological testing, including highly positive Weil- Felix titers, provided strong evidence supporting the diagnosis of rickettsial infection. The prompt initiation of doxycycline therapy, a first-line treatment for rickettsial infections, led to a remarkable improvement within 48 hours. This rapid response to appropriate antimicrobial medication further supported the suspected diagnosis. It is important to consider rickettsial infection in the differential diagnosis of non-aneurysmal subarachnoid hemorrhage. In conclusion, this case underscores the diverse clinical manifestations of rickettsial infection, including the potential to affect the central nervous system and mimic other neurological conditions. Early diagnosis and treatment can prevent further complications and facilitate a full recovery.