Background <p>Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne viral disease caused by Dabie bandavirus, associated with high morbidity and mortality. Neurological complications such as encephalopathy are increasingly recognized and are linked to poor prognosis. No specific antiviral treatment is available, and management is mainly supportive.</p> Case presentation <p>We report a rare case of SFTS in a 72-year-old woman who developed acute encephalopathy and multi-organ dysfunction shortly after a wasp sting. The patient presented with thrombocytopenia, elevated liver enzymes, and central nervous system involvement, including seizures and coma. Next-generation sequencing and serological testing confirmed SFTS. Despite standard antiviral and supportive therapies, rapid deterioration prompted therapeutic plasma exchange (TPE) initiation. After two sessions of TPE, the patient showed significant clinical improvement, including recovery of consciousness, normalization of laboratory markers, and resolution of neurological symptoms.</p> Conclusion <p>This case highlights the potential utility of early TPE in managing fulminant SFTS with central nervous system involvement. TPE may attenuate cytokine-mediated inflammation and improve outcomes in patients with severe Bunyavirus-associated encephalopathy. Further studies are warranted to standardize its use in this context.</p> Clinical trial <p>Not applicable.</p>