Rickettsioses complicated with dry gangrene and thrombotic thrombocytopenic purpura -a case report

Background: Spotted fever group rickettsioses has become more apparent in certain provinces of Sri Lanka. It has a vast diversity in its clinical presentation. However, toe gangrene and thrombotic thrombocytopenic purpura are rare presentations of rickettsioses and are less reported to date. Case presentation: Acute febrile illness of a 28year old Army Officer was complicated with seizures, acute kidney injury, toe gangrene and skin necrosis. He was treated as for spotted fever group rickettsioses complicated with dry gangrene and thrombotic thrombocytopenic purpura. Accurate clinical diagnosis and specific treatment resulted in dramatic recovery leaving behind only the residual gangrenous toes. Conclusion: This case report highlights the importance of accurate clinical diagnosis along with timely intervention to determine the outcome of certain detrimental and rare complications of spotted fever group rickettsioses.