Murine Typhus Mimicking Preeclampsia With Severe Features

Background: Murine typhus, a flea-borne rickettsiosis endemic to southern Texas, can cause headache, thrombocytopenia, and transaminitis that overlap with the criteria for preeclampsia with severe features. Case: A 22-year-old gravida 5 with gestational hypertension presented at 32 5/7 weeks of gestation with 5 days of fever and headache. Worsening thrombocytopenia, transaminitis, and refractory headache were initially attributed to preeclampsia with severe features, and magnesium sulfate was administered. Persistent fever prompted empiric doxycycline for suspected murine typhus; defervescence occurred within 48 hours, and acute serology supported the diagnosis. She delivered a healthy neonate at 37 weeks. Conclusion: In endemic regions, murine typhus should be considered in febrile pregnant patients with preeclampsia-like laboratory findings, and empiric doxycycline should not be delayed for serologic confirmation.