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To the Editor.
—In June 1992, a 65-year-old white male resident of Talbot County, Maryland, developed an acute febrile rash suggestive of Rocky Mountain spotted fever (RMSF). For 2 days he experienced malaise, sneezing, coughing, and generalized aching. On the third day, he developed fever (38.3°C to 39.7°C [101°F to 103.5°F]) and severe headache. On the fourth day, a generalized macular rash appeared on the trunk, arms, and legs, most intense on the anterior thighs. There was no rash on the scalp, face, palms, or soles. Examination revealed no findings indicative of meningitis, rubella, rubeola, varicella, or infectious mononucleosis. Laboratory studies revealed a white blood cell count of 4.3×109/L, segmented neutrophils of 0.80, and bands of 0.13; 20 other blood analytes were normal. The patient was not aware of any insect bites preceding illness. Doxycycline was started the first day of rash and continued with dosage of 100
Long JW. Do We Have Yet Another Spotted Fever? JAMA. 1993;270(17):2051–2052. doi:10.1001/jama.1993.03510170041018
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