A 6-year-old girl with fever, rash, and increased intracranial pressure

Matthew E. Ravish, Daniel P. Krowchuk, Michael Zapadka, Avinash K. Shetty

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Rocky Mountain spotted fever (RMSF) is a well-described, potentially lethal, tick-borne zoonotic infection and has very effective therapy. However, the diagnosis might not be made early enough, often leading to worse outcomes. Objective: Our aim was to discuss the diagnostic dilemmas facing the physician when evaluating patients with suspected RMSF. Methods: We report a case of RMSF in a 6-year-old girl who presented to our hospital with a 7-day history of fever, headache, and a petechial rash. After blood cultures were obtained, the patient was treated empirically with doxycycline, vancomycin, and ceftriaxone. During the next 24 h, her clinical status worsened, with acute onset of altered mental status, posturing, and fixed and dilated pupils. A computed tomography scan of the brain demonstrated diffuse cerebral edema with evidence of tonsillar herniation. She died 24 h after admission. A serum specimen tested positive for immunoglobulin G to Rickettsia rickettsii at a titer of 128 dilutions, confirming recent infection. Conclusions: We present this case to raise awareness of RMSF in patients who present with a nonspecific febrile illness in tick-endemic areas in the United States. Early diagnosis and treatment with doxycycline before day 5 of illness is essential and can prevent morbidity and mortality.

Original languageEnglish
Pages (from-to)186-189
Number of pages4
JournalJournal of Emergency Medicine
Volume45
Issue number2
DOIs
Publication statusPublished - 01-08-2013
Externally publishedYes

Fingerprint

Rocky Mountain Spotted Fever
Intracranial Pressure
Exanthema
Fever
Doxycycline
Rickettsia rickettsii
Pupil Disorders
Tick-Borne Diseases
Encephalocele
Sick Leave
Ceftriaxone
Brain Edema
Zoonoses
Ticks
Vancomycin
Headache
Early Diagnosis
Immunoglobulin G
Tomography
Morbidity

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

Ravish, Matthew E. ; Krowchuk, Daniel P. ; Zapadka, Michael ; Shetty, Avinash K. / A 6-year-old girl with fever, rash, and increased intracranial pressure. In: Journal of Emergency Medicine. 2013 ; Vol. 45, No. 2. pp. 186-189.
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A 6-year-old girl with fever, rash, and increased intracranial pressure. / Ravish, Matthew E.; Krowchuk, Daniel P.; Zapadka, Michael; Shetty, Avinash K.

In: Journal of Emergency Medicine, Vol. 45, No. 2, 01.08.2013, p. 186-189.

Research output: Contribution to journalArticle

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