Transesophageal and transthoracic echocardiograms did not show evidence of infective endocarditis or myocarditis. ASOT titre was <200 Units. Chest radiograph was normal, and ultrasound scan of the abdomen revealed mild hepatomegaly. Intravenous vancomycin, oral doxycycline and azithromycin were added on the 3rd day of admission to cover severe gram positive sepsis and rickettsial infections. The IFA-IgG titre against Rickettsia conorii Ag was positive at a titre of 1: 8192 and leptospira antibodies were negative by both Microscopic Agglutination Test and ImmuneMed Leptospira Rapid Immuno-Chromatographic assay for qualitative detection of IgM, IgG antibodies to Leptospira. The patient showed gradual improvement with reduction in fever by the 2ndday of doxycycline (5th day of admission) and had a complete recovery from acute kidney and liver injury by the 4th treatment day. However, her skin rash and the joints became very painful over the 2nd-4th days of treatment. All these resolved completely within 5 days of treatment (8th day of admission), and she was discharged on the 11thday of admission. On review after one week of discharge, her rash had started to desiccate and peel off (Fig. 5). The timeline diagram of the evolution of illness is give in Fig. 6.Fig. 5Peeling of the skin over the areas of subcutaneous necrosis Fig. 6The timeline diagram of the evolution of illness