Encefalite por Rickettsia sem exantema: a propósito de um caso clínico

Objective:: To report a rare case of Rickettsia encephalitis without exanthema. Case report:A 44-year-old male patient, a rural worker, presented daily fever, myalgia and asthenia progressing with left eye amaurosis, ataxia, mental fluctuation, paraparesis of the lower limbs, and divergent strabismus on the left. He was treated empirically with Ceftriaxone and dixiclin for Brucellosis, Rickettsia and Lyme. Positive laboratory test for Rickettsia rickettsii. Discussion: Macular Fever is an acute febrile infectious disease caused by Rickettsia rickettsii. It is acquired by the bite of the infected tick, of the genus Amblyomma. It presents a variable clinical course. The onset of symptoms is usually abrupt and nonspecific. Neurological manifestations are present in about 40% of the cases. The indirect immunofluorescence reaction is the gold standard for diagnosis. The drugs most effective for the treatment are: doxycycline and chloramphenicol. In Brazil, mortality rates are around 20-30%. Comments:Clinical suspicion and early initiation of targeted antibiotic therapy are critical to prevent more severe manifestations and to allow therapeutic success.