Pleural effusion caused by Rickettsia felis infection.

INTRODUCTION

Rickettsia felis, a Gram-negative obligate intracellular prokaryotic organism, causes human infections with atypical clinical presentations, commonly including fever, fatigue, headache, and maculopapular rash.

CASE PRESENTATION: This study presents a rare case of pleural effusion (PE) associated with R. felis infection, confirmed through targeted next-generation sequencing (tNGS). The patient showed significant clinical improvement and resolution of PE following empirical moxifloxacin followed by pathogen-directed therapy with rifampicin and azithromycin, along with supportive measures for circulation and immune function.

CONCLUSIONS

This case report aims to enhance early diagnosis and therapeutic strategies for R. felis infections by sharing the diagnostic and management experience.