Case history
Case history
An 8-year-old boy presents to an emergency department in the southeastern US in June with a 5-day history of fever, headache, vomiting, myalgia, and abdominal pain and a 2-day history of a rash, which was first noted over the wrists and ankles. He frequently spends time outdoors and had returned from a camping trip 1 week before these symptoms began. On physical examination the patient has a temperature of 40.5°C (105°F) and appears uncomfortable. He is sleepy but arousable. Mild conjunctival hyperaemia is present. The abdomen is minimally tender and the spleen tip is palpable. A maculopapular rash covers most of his arms and legs, including the palms and soles, and several discrete petechiae are also present over the extremities.
Other presentations
Because Rocky Mountain spotted fever is a multi-system vasculitis, its manifestations can be related to virtually any organ. Less frequently noted, findings that may occur later in the presentation include mental status impairment, meningismus/meningitis, conjunctivitis, lymphadenopathy, periorbital or peripheral oedema, hepatosplenomegaly, or jaundice. Abdominal pain mimicking appendicitis, or gastroenteritis may be observed and is more common in children. Uncommon findings include pneumonitis, focal neurological deficits, coma, seizures, shock, arrhythmias, or myocarditis.
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