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 2 Diagnosis and treatment process of FUO.
| Step | Specific actions | Key notes (rickettsial focus) |
|---|---|---|
| 1. Initial assessment | Case relevance: Grassland exposure and fever pattern support rickettsial etiology | |
| 2._Laboratory screening | Limitation: Delayed antibody rise → repeat serology if early negative | |
| 3. Imaging | Case note: Normal CXR despite systemic inflammation; consider CT if progression | |
| 4. Empirical therapy | Case outcome: Fever resolved within 72 h of doxycycline, confirming empiric therapy efficacy | |
| 5._Confirmatory diagnosis | Case gap: Biopsy not performed but clinical response supports diagnosis | |
| 6. Follow-up | Long-term monitoring: Screen for chronic complications (e.g., endocarditis) if relapse suspected |