Rocky Mountain Spotted Fever Case Study

Rocky Mountain spotted fever (RMSF) is a tick borne illness that is prevalent in the summer months primarily in the south and central United States. Patients with delayed diagnosis can have increased morbidity, particularly poor neurological outcome. We present a case of a 7-year-old girl with RMSF diagnosed on day 8 of illness who had severe neurological changes and hypotensive shock. Magnetic Resonance Imaging (MRI) of the brain demonstrated “starry sky” appearance with numerous punctate foci of restricted diffusion within the supratentorial brain including the corpus callosum and basal ganglia which has been previously described as characteristic of RMSF. She was treated with intravenous immunoglobulin (IVIG) on the day of admission a presumptive diagnosis of Kawasaki Disease. She ultimately did well with

Howard Ricketts (1). Infection produces a small to medium-sized vessel vasculitis manifesting in the classic clinical triad of fever, headache and rash (1). Prompt diagnosis and treatment results in an excellent prognosis; however, patients who experience a delay in diagnosis may have increased morbidity and mortality. Patients with altered mental status and coma secondary to RMSF are at increased risk of death or poor neurological recovery (2). There are two prior case reports of pediatric patients with RMSF who had a MRI of the brain with findings typical of the “starry sky” appearance (3,4). One case is remarkably similar to ours; however, that patient had ongoing vasculitis despite antibiotic therapy and ultimately had a poor neurological outcome (4). We present a case of a 7-year-old female with delayed diagnosis of RMSF, altered mental status and hypotension who was treated with intravenous immunoglobulin (IVIG) for the presumed but incorrect initial diagnosis of Kawasaki Disease and had a good neurological