The occurrence of PF or ‘fern leaf’ type of rash seems to be rare in rickettsial infections. While PF has been described mainly in the children [9–11], ‘fern leaf rash has been observed in several elderly patients with SFGR in the central province of Sri Lanka [3, 6, 7, 12]. However, this young female patient very rapidly developed a widespread ‘fern-leaf’ pattern rash over the 10th and 11th days of illness together with DIC suggesting early PF. It was noted predominantly over the breasts and proximal limbs with facial sparing. The rash was painful and tender. The tenderness increased during the first three days after commencement of specific treatment and later improved in parallel with the other clinical manifestations. She also had splinter hemorrhages and a vasculitic rash on the palms and soles. This patient did not have an eschar or marks of tick bites and eschars are an uncommon feature in patients with SFGR compared to scrub typhus in Sri Lanka .