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General Rehabilitation

Rickettsia conorii israelensis infection complicated by quadruple-limb amputation: A case report

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 3

    Poster Presenter(s)

  • Miriam S. Borvick

    Medical Student
    Kirk Kerkorian School of Medicine at UNLV
    Las Vegas, Nevada

    • Co-Author(s)

  • SD

    Shulamit Diena, Other

    Medical Student
    Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
    North York, Ontario, Canada

  • AF

    Alan Friedman, MD

    Director, Physical Medicine
    Soroka University Medical Center
    Ramat Beit Shemesh, Yerushalayim, Israel

  • Michael Glukhoded, MD

    Head of Pediatric Rehabilitation Service
    Soroka university medical center
    Beer sheva, Israel

  • CB

    Cheryl Benjamin, DO

    Associate Program Director
    Schwab Rehabilitation Hospital & Care Network/University of Chicago PM&R Program
    Skokie, Illinois

Disclosure(s):
Miriam S. Borvick: No financial relationships to disclose
Alan Friedman, MD: No financial relationships to disclose
Michael Glukhoded, MD: No financial relationships to disclose
Case Diagnosis: A 40-year-old male with quadruple-limb amputation secondary to severe systemic Rickettsia conorrii subsp. israelensis infection

Case Description or Program Description: The patient presented with complaints of headache, fever and rash. Despite empiric antibiotic therapy, his condition deteriorated to multi-organ failure, sepsis, and a diffuse purpura fulminans-like petechial rash. Workup confirmed Rickettsia conorii israelensis infection. While his condition stabilized with targeted antibiotic therapy, ischemia to all limb extremities progressively worsened. Once stable, he underwent step-wise, quadruple-limb amputation, including bilateral below-knee amputations, amputation up to the right distal ulna, and disarticulation of all digits at varying joints in the left hand.

Setting: Acute inpatient rehabilitation unit in a level 1 trauma center

Assessment/Results: On admission to rehabilitation following surgeries, the patient required total assistance for transfers, wheelchair propulsion and lower body dressing; maximal assist for grooming, bathing and toileting; moderate assist for upper body dressing; and standby assist (SBA) for eating. At discharge, he achieved significant functional gains, progressing to modified independence for eating; SBA for bed/chair/wheelchair transfer; minimal assist for toileting and toilet transfer; and moderate assist for bathing, lower body dressing, bath/shower transfer and wheelchair propulsion.

Discussion (relevance): R. conorii israelensis is a tick-borne subtype of Rickettsia with a clinical presentation of Israeli spotted fever. Common manifestations include fever, headache, maculopapular rash, myalgia and thrombocytopenia. This is the first reported case, to our knowledge, of limb amputation secondary to R. conorii israelensis infection, with the exceptionally severe outcome of quadruple-limb amputation. Amputation is a rare complication of any Rickettsial infection, and quadruple-limb amputation is exceedingly rare.

Conclusions: Quadruple-limb amputation is an extremely rare, severe outcome of Rickettsia infection, with significant resultant functional impairments. This case underscores the importance of recognizing severe Rickettsiosis complications and initiating early rehabilitation to optimize functional outcomes in cases resulting in amputation.