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
WALKER DH, HENDERSON FW, HUTCHINS GM. Rocky Mountain Spotted Fever: Mimicry of Appendicitis or Acute Surgical Abdomen? Am J Dis Child. 1986;140(8):742–744. doi:10.1001/archpedi.1986.02140220024020
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