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The Rickettsiae are small gram-negative bacteria, which are generally obligate intracellular parasites and transmitted to humans by arthropods. 1 The exception is Coxiella burnetii, which is transmitted by inhalation and has an endospore form that is capable of surviving in an extracellular environment. 2, 3 The most common rickettsial infections are Rocky Mountain spotted fever, epidemic typhus, and Q fever. Rickettsial infections except for Q fever typically present with fever, rashes, and vasculitis. Imaging findings of central nervous system (CNS) involvement in Rocky Mountain spotted fever reported to date include diffuse cerebral edema, meningeal enhancement, arterial infarction, and signal abnormality within the distribution of perivascular spaces, which are dissimilar to the documented neuroimaging findings of Q fever consisting of (meningo) encephalitis, acute cerebellitis, and transverse myelitis. 4–9 To the …