ROCKY Mountain spotted fever (RMSF) is an acute, febrile, exanthematous illness caused by Rickettsia rickettsii and transmitted by the bite of a tick. This infectious disease is endemic in the South Atlantic states, and the case-fatality rate is increasing. Reduction of mortality requires early diagnosis with recognition of the cardinal features of the illness, such as fever, characteristic rash, history of tick contact, and myalgias. Unfortunately, lack of documented tick exposure, late onset of rash, and gastrointestinal complaints are more frequently associated with fatal cases.1 Rocky Mountain spotted fever may present in unusual and unfavorable forms, such as fulminant fatal disease and a viscerotrophic variety in which cutaneous manifestations are delayed or absent entirely.2 It should be recognized that rickettsial vasculitis may involve the abdominal wall and abdominal viscera, and mimic acute appendicitis. Significant abdominal pain leading to laparotomy was present in the cases reported here. These cases
Davis AE, Bradford WD. Abdominal Pain Resembling Acute Appendicitis in Rocky Mountain Spotted Fever. JAMA. 1982;247(20):2811–2812. doi:10.1001/jama.1982.03320450045032
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