Background <p><i>Rickettsia felis</i> is a zoonotic pathogen belonging to the <i>Rickettsia</i> genus. Infection of children with central nervous system <i>Rickettsia feli</i>s is very rare, with only a few cases reported worldwide.</p> Case presentation <p>We conducted a retrospective analysis of the clinical data, laboratory tests, and imaging results for a pediatric patient diagnosed with <i>Rickettsia felis</i> meningoencephalitis. The patient, an adolescent, initially presented with fever and headache. The condition progressed rapidly within six hours of admission, manifesting as photophobia, lethargy, and nuchal rigidity. The cerebrospinal fluid (CSF) analysis revealed leukocytosis, while cranial magnetic resonance imaging displayed abnormal signals in both basal ganglia and frontal-parietal regions. Detection of <i>Rickettsia felis</i> was confirmed through targeted next-generation sequencing (tNGS) of the CSF. The patient underwent a comprehensive treatment regimen including doxycycline for infection control, alongside glucocorticosteroids and gammaglobulin to manage symptoms and reduce intracranial pressure. The child fully recovered. One month after admission to the hospital for treatment, the child recovered. A month later, the child’s CSF was normal and the child recovered completely.</p> Conclusion <p>This case underscores the importance of enhancing pediatricians’ and infectious diseases and neurology experts’ comprehension of <i>Rickettsia felis</i> meningoencephalitis through shared diagnostic and therapeutic insights.</p>