Question

10 year-old male complains of fever and rash (shown below); no other complaints. He went camping 10-days ago. What’s the diagnosis...and what medication(s) should he receive?

Answer

Rocky Mountain spotted fever (RMSF)

• Tick-borne disease caused by the organism Rickettsia rickettsia; endemic in North, Central, and South America; especially prevalent in southeastern and south-central US
• Consider diagnosis in patients with unexplained fevers, even without history of a tick bite (reported in only 70%)
• Common symptoms include:
  • Fever
  • Headache
  • Maculopapular rash (see below)
  • GI symptoms (e.g., nausea, vomiting, etc.)
  • Myalgias
  • CNS  (encephalitis, delirium, seizures, etc.)
• Classic maculopapular rash appears up to 7 days after fever; starts on wrists and ankles then centripetally spreads to involve the trunk and extremities (including the palms and soles); face is typically spared. In children, periorbital edema is a diagnostic clue.
• Up to 25% mortality if untreated, but is 5% with appropriate antibiotics; doxycycline is the preferred drug for adults and children; chloramphenicol is an alternative agent and used primarily in pregnant women.

References

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