Balancing Empirical Treatment and Comprehensive Evaluation in a Case of Suspected Rickettsial Infection: A Diagnostic Dilemma in Recurrent Fever.

BACKGROUND Fever, defined as an elevation in body temperature beyond the normal range, presents a diagnostic and therapeutic challenge due to its multifactorial etiology. The purpose of publishing this case report is to highlight the diagnostic challenges posed by recurrent fever and emphasize the importance of a systematic and comprehensive approach, while also proposing a novel diagnostic algorithm to improve management and minimize unnecessary antibiotic use. CASE REPORT We report a case of a 26-year-old woman with recurrent fever, headache, and myalgia, unresponsive to initial antiviral and antibiotic therapies. Despite negative viral and bacterial tests, various medications failed to produce significant clinical improvement. Elevated liver function tests and procalcitonin levels suggested an atypical infection. Administration of doxycycline led to symptom alleviation; however, the diagnosis remains unconfirmed without definitive testing. This case underscores the importance of adopting a systematic and comprehensive diagnostic approach for unclear illnesses. While empirical treatment may be necessitated, caution is urged to avoid unjustified use of antibiotics and medications without a clear diagnosis. Balancing empirical therapy with thorough evaluation is crucial for effective fever management, minimizing the risks of misdiagnosis or inappropriate treatment. We propose a novel diagnostic algorithm integrating rapid molecular diagnostics and advanced imaging to minimize unnecessary antibiotic use and improve patient outcomes. CONCLUSIONS The management of recurrent febrile illnesses requires a balanced approach, integrating empirical treatment with comprehensive diagnostic evaluation. Our proposed diagnostic algorithm offers a structured pathway to improve patient outcomes and reduce unnecessary antibiotic use. Further research is essential to validate this approach and establish standardized protocols for fever management.