One case of encephalitis caused by Rickettsia felis without fever

We present a case report of a woman who has a Rickettsia felis infection with a variety of neurological symptoms, including epilepsy, headache, memory loss, personality changes, apraxia, disorientation and binocular vision impairment. Her temperature is normal. Differential diagnoses included epilepsy, viral encephalitis, autoimmune encephalitis, and intracranial tumor. An enhanced MRI scan revealed a ring-enhancing lesion in brain, which prompted the clinician to refine subsequent cerebrospinal fluid mNGS sequencing, resulting in a definitive diagnosis of Rickettsia felis encephalitis.