Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Rocky Mountain Spotted Fever, carried by a variety of ticks, is classically caused by Ricksettsia rickettsii, but may be clinically indistinguishable from other bacteria in the same family. A 47 year old female presented in December for presurgical clearance due to fever, petechial rash on the thighs and trunk, and ecchymoses on the forearms, gluteal region, and toes; additional symptoms included arthralgia in bilateral lower limbs. Bacterial infection was suspected and empirical doxycycline was initiated pending specific PCR testing. Patient adherence was unclear at the followup visit, so IV ceftriaxone was initiated and repeated immunoglobulin testing was ordered to follow her course. Her symptoms waxed and waned over the next several weeks, but ultimately improved and resolved over the next two months, at which point she was successfully cleared for surgery. This case was unusual as she presented in December but disease prevalence typically wanes by August. She was evaluated by rheumatology and dermatology for arthralgia and rash prior to presentation to infectious disease service, but prior treatment was unsuccessful; a missed opportunity to prevent delay in surgery and potential sequelae of long-term infectious vasculitis. As changes in climate increase host range for the variety of vectors, geographic range and temporal duration is also expected to increase, and so it should be considered in the differential more frequently.
Keywords
Rocky Mountain Spotted Fever, tick-borne diseases, Spotted Fever Group Rickettsiosis, infectious disease, dermatology, Differential Diagnosis
Disciplines
Medicine and Health Sciences
Document Type
Poster
DOI
10.31986/issn.2689-0690_rdw.stratford_research_day.77_2024
Included in
Rocky Mountain High Titer: An Unusual Delay In Surgical Clearance
Rocky Mountain Spotted Fever, carried by a variety of ticks, is classically caused by Ricksettsia rickettsii, but may be clinically indistinguishable from other bacteria in the same family. A 47 year old female presented in December for presurgical clearance due to fever, petechial rash on the thighs and trunk, and ecchymoses on the forearms, gluteal region, and toes; additional symptoms included arthralgia in bilateral lower limbs. Bacterial infection was suspected and empirical doxycycline was initiated pending specific PCR testing. Patient adherence was unclear at the followup visit, so IV ceftriaxone was initiated and repeated immunoglobulin testing was ordered to follow her course. Her symptoms waxed and waned over the next several weeks, but ultimately improved and resolved over the next two months, at which point she was successfully cleared for surgery. This case was unusual as she presented in December but disease prevalence typically wanes by August. She was evaluated by rheumatology and dermatology for arthralgia and rash prior to presentation to infectious disease service, but prior treatment was unsuccessful; a missed opportunity to prevent delay in surgery and potential sequelae of long-term infectious vasculitis. As changes in climate increase host range for the variety of vectors, geographic range and temporal duration is also expected to increase, and so it should be considered in the differential more frequently.