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July 1991

Petechial Rash in Toxic-Appearing Young Man

Arch Dermatol. 1991;127(7):1049-1050. doi:10.1001/archderm.1991.01680060123018

REPORT OF A CASE  A 22-year-old white man presented to the emergency room with a 4- to 5-day history of fever, chills, myalgias, arthralgias, severe headache, and photophobia. The patient had noted a rash for 3 days that began on the right anterior aspect of his thigh and rapidly spread to involve the rest of his extremities, palms, soles, and trunk. Subsequently, diffuse abdominal pain, anorexia, and diarrhea developed. Postural dizziness occurred on the day of admission.The patient stated that for the 10 days preceding his illness he had worked cutting timber in a wooded area near his home. Although he did not remember being bitten by a tick, he recalled brushing ticks off his clothing.At the time of admission, the patient's supine blood pressure was 96/60 mm Hg, with a resting tachycardia of 140 beats per minute and a temperature of 39.7°C. His abdomen was diffusely tender;