18 August 2025
: Case report 
Balancing Empirical Treatment and Comprehensive Evaluation in a Case of Suspected Rickettsial Infection: A Diagnostic Dilemma in Recurrent Fever
Unknown etiology, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Educational Purpose (only if useful for a systematic review or synthesis)
Jing Ding ABCEF 1, Ju Tian ABF 1*, Xingqi Chen ABCDEF 1,2DOI: 10.12659/AJCR.948614
Am J Case Rep 2025; 26:e948614
Table 1 Detailed process of treatment and abbreviations for tests and examinations.
| Onset time (days) | Symptoms | Laboratory tests | Imaging findings | Treatment regimen |
|---|---|---|---|---|
| Day 3 | Recurrent fever (38.5–39.2°C), headache, myalgia | WBC: 2.85×10/L (↓3.69–9.16) NEUT%: 67.0% LYMPH%: 25.3% (↓20.0–40.0) EO%: 0% (↓0.5–5.0) | N/A | Hydration, loxoprofen sodium, traditional Chinese medicine |
| Day 5 | Recurrent fever (38.5–39.0°C), headache, myalgia | Influenza A/B, RSV, HRV, MP: All negative WBC: 4.63×10/L LYMPH%: 26.13% (↓20.0–40.0) | N/A | Oseltamivir (75 mg PO BID) + levofloxacin (0.5 g PO QD) + ibuprofen |
| Day 7 | Recurrent fever (38.3–39.2°C), headache, myalgia | – | N/A | Azithromycin (0.5 g PO QD) + ibuprofen |
| Day 9 | Recurrent fever (38.5–39.2°C), headache, myalgia | ALT: 275 U/L (↑7–40) AST: 98 U/L (↑13–35) PCT: 0.29 ng/mL (↑0.00–0.05) WBC: 5.35×10/L | X-ray: Normal | Doxycycline hyclate (0.1 g PO q12 h) |
| Day 10 | Afebrile, no abnormal physical examination findings | – | N/A | Continued doxycycline hyclate |
| Post-fever (Day 16) | Resolution of symptoms | ALT: 28 U/L AST: 20 U/L Alb: 43.3 g/L TBIL: 12.6 μmol/L | N/A | Discontinued antibiotics |
| WBC – white blood cell count; NEUT% – neutrophil percentage; LYMPH – lymphocyte percentage; MONO% – monocyte percentage; EO% – eosinophil percentage; BASO% – basophil percentage; NEUT# – neutrophil absolute value; LYMPH# – lymphocyte absolute value; MONO# – monocyte absolute value; BASO# – eosinophil absolute value, basophil absolute value; 2019-nCoV – COVID-19 nucleic acid; FluAV – influenza A virus; FluBV – influenza B virus; RSV – respiratory syncytial virus; Radv – respiratory adenovirus; HRV – human rhinovirus; MP – ; ALT – alanine aminotransferase; AST – aspartate aminotransferasel Alb – albumin Glb – globulin; TBIL – total bilirubin; DBIL – direct bilirubin; IBIL – indirect bilirubin; PCT – procalcitonin | ||||