Objective To report a case of tick-borne Far-Eastern spotted fever caused by Rickettsia heilongjiangensis in Jining, Shandong province in 2025 and provide evidence for the early identification of the disease.

Methods The information about the basic characteristics, health examination results upon admission, clinical laboratory test results, immunological and physical examination results, epidemiological investigation data, treatment and prognosis of the case were collected. Blood samples of the case were sent to the National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention for DNA extraction for the screening of common tick-borne pathogens by nested polymerase chain reaction (PCR), and phylogenetic analysis.

Results The case was a 61-year-old women (farmer) with high fever, chills, headache, bilateral knee joint pain accompanied by scattered red rashes. The routine blood test showed a slightly decreased lymphocyte ratio and a slightly increased neutrophil percentage; liver function, biochemical and lipid tests showed a slightly decreased total protein level, slightly increased glutathione reductase and adenosine deaminase, and procalcitonin level; the myocardial enzyme spectrum test showed a mild decrease in creatine kinase level; among the inflammatory indicators, serum amyloid A and high-sensitivity C-reactive protein levels significantly elevated. Treatment was given during hospitalization by using piperacillin sodium and tazobactam sodium, and compound aminopyrine and phenobarbital, etc. The case was discharged from hospital after improvement in health status. The blood test further confirmed Rickettsia heilongjiangensis infection by nested PCR. Epidemiological investigation showed the case had a history of outdoor activity in the mountainous area of Fujin, Jiamusi, Heilongjiang province, having exposure to bite by an unidentified arthropod.

Conclusion This case was the first case of tick-borne Far-Eastern spotted fever in Shandong. It is necessary to strengthen the investigations and monitoring of vectors, host animals and populations in potential foci, and health education about tick-borne diseases.