Posterior reversible encephalopathy syndrome associated with Rickettsia conorii infection: a rare case report.

OBJECTIVES

Posterior reversible encephalopathy syndrome (PRES) is an uncommon but serious neurological complication characterized by headache, seizures, visual disturbances, and altered mental status, and associated with parieto-occipital vasogenic edema on neuroimaging. Rickettsial infections have rarely been reported as triggers of PRES.

METHODS

In this report, we describe the case of a 26-year-old man with rickettsial infection in Iran who developed a diffuse petechial rash, acute kidney injury, recurrent seizures, and bilateral cortical blindness.

RESULTS

Brain magnetic resonance imaging revealed extensive parieto-occipital hyperintensities consistent with PRES. An indirect immunofluorescence assay demonstrated a fourfold rise in immunoglobulin M titers against Rickettsia conorii from 1:24 to 1:96, confirming acute R. conorii infection.

CONCLUSION

This case highlights R. conorii as a rare infectious cause of PRES and underscores the importance of early recognition and empiric treatment in endemic settings.