Spotted Fever Rickettsial Infection in Pregnancy Causing Acute Hepatitis, Fatal Postpartum Hemorrhage and Possible Vertical Transmission

We present a rare case of a 31-year-old pregnant mother in 37 weeks of gestation who presented with a 3-day history of vomiting, epigastric pain, and icterus, subsequently diagnosed as a rickettsial disease in pregnancy (with positive IgG titer for SFG) complicated with hepatitis, coagulopathy, pulmonary hemorrhage, and post-partum hemorrhage, who expired despite intensive care management. The newborn baby also had high IgG titer for SFG suggesting a vertical transmission of the disease and recovered following treatment with chloramphenicol. The SFG rickettsial infection can cause diverse clinical manifestations in pregnancy including acute hepatitis and coagulopathy. Therefore, the possibility of SFG rickettsial infection needs to be considered in diagnostic workup in obscure clinical presentations. We postulate possible vertical transmission of SFG to newborns which needs further confirmation.