August 1986

Rocky Mountain Spotted Fever: Mimicry of Appendicitis or Acute Surgical Abdomen?

Author Affiliations

Department of Pathology
Department of Pediatrics The Medical School University of North Carolina at Chapel Hill Chapel Hill, NC 27514
Department of Pathology The Johns Hopkins Hospital Baltimore, MD 21205

Am J Dis Child. 1986;140(8):742-744. doi:10.1001/archpedi.1986.02140220024020

Sir.—Rocky Mountain spotted fever (RMSF) is a potentially life-threatening, tickborne rickettsial disease. It is often difficult to diagnose, not only because the triad of fever, rash, and history of tick exposure is present in only 3% of patients during the first three days of illness,1 but also because other symptoms such as nausea, vomiting, abdominal pain, and diarrhea may be prominent.2,3 Delay in diagnosis is associated with a striking increase in mortality.1 We describe two patients whose cases expand the spectrum of documented gastrointestinal tract involvement: one from whom a normal appendix was removed and in whom a stormy course of RMSF ensued, and one in whom a perforated appendix that resulted from appendiceal rickettsial vascular injury was observed at autopsy.

Patient Reports.—Patient 1.—A 4-year-old girl was bitten by a tick one week before the onset of illness. She initially had fever, malaise, and

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