The clinical spectrum of severity of rickettsial infections ranges from subclinical to fatal and presents with fever and may progress to various organ involvement such as encephalitis, interstitial pneumonia/ARDS, acute renal failure or with multiple organ failure. Furthermore, we have encountered patients with rickettsial illness, either SFGR or ST with illness mimicking acute rheumatic disease . Although most of the patients with SFG rickettsial disease have an unremarkable course, patients who develop complications related to organ involvement may suffer severe illness with mortality up to 2.5% among diagnosed cases . Classical risk factors for high mortality or severe forms of infection include advanced age, chronic alcoholism, glucose-6-phosphate-dehydrogenase deficiency, prior prescription of an inappropriate antibiotic, particularly sulfonamides, or delay in the treatment . Therefore, early clinical suspicion and empiric treatment with anti-rickettsial antibiotics are important in reducing duration of illness and mortality. It is important that rickettsial infections should always be considered in the differential diagnosis of acute febrile illness in endemic areas.