UMEM Educational Pearls

Title: What's the Diagnosis? Image by UMEM alumni Dr. Adam Friedlander

Posted: 7/6/2014 by Haney Mallemat, MD (Updated: 7/7/2014)
Click here to contact Haney Mallemat, MD

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

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)