Rocky Mountain spotted fever differential diagnosis
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Rocky Mountain spotted fever Microchapters |
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Differentiating Rocky Mountain spotted fever from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.
Overview
In virtually all cases, Rocky Mountain spotted fever presents with a rash. When trying to differentiate RMSF with other infections, it should be noted that there has been a rare case in which RMSF has presented without the typical rash.
Case Study
A crucial piece of the Rocky Mountain spotted fever puzzle has to do with making an early diagnosis, which can prove very difficult at times. It can be especially difficult when a patient doesn't present with the symptoms normally associated with the specific infection. A rare symptom of RMSF is severe rhabdomyolysis in which all of the known cases present with an accompanying rash[1]. There was an unusual case that presented a young male who has severe rhabdomyolysis without an accompanying rash.
Presentation of 16 year old male[1].
- Hospitalized for 4 days with high fever
- Gastrointestinal symptoms for 2 days
- Severe pain in lower extremities
- Walking became difficult
- No history of
- Tick bite
- Travel
- Sick contact
- No rash but extreme tenderness in both thighs
- Motor testing was limited (due to pain)
- Neurological testing was normal
Laboratory findings[1].
- Thrombocytopenia
- Hyponatremia
- Elevated liver enzymes.
- Elevated C reactive protein.
- Myoglobinuria shown in urinalysis
- CPK levels up to 19,915 (very high)
- Concentrations for RMSF were positive which confirmed the diagnosis.
Conclusion[1].
- Doxycycline was the treatment of choice for 10 days
- Patient was afebrile after 3 days
- Patient began walking after a week
- RMSF should be considered as a possible diagnosis even if a rash is not present. It can be considered a rare cause of severe rhabdomyolysis after common causes have been sufficiently ruled out.