RMSF

RMSF is a tick-borne illness predominately diagnosed in the summer months in the south and central United States. It is caused by the bacterium Rickettsia rickettsia that upon infection localizes and multiplies in endothelial cells of small to medium-sized blood vessels resulting in vasculitis (1). The vasculitis results in the classic triad of fever, headache and rash, however, only slightly more than half of children with RMSF will have the classic triad and less than half will have a history of tick attachment (1,2). Patients who are diagnosed and treated early with doxycycline have an excellent prognosis. Delayed diagnosis, defined as occurring after the fifth day of symptoms, can have significant morbidity and mortality. Pediatric patients aged 5-9 years have the highest case fatality rate for RMSF. This rate has actually increased in recent years despite the widespread availability of effective therapy (5). Patients with a delayed diagnosis of RMSF frequently will have sought medical care in the preceding days, with the diagnosis of RMSF going unconsidered (2).
To our knowledge, …show more content…
Our patient was diagnosed late in her disease course and had hypotension and neurological changes both which are predictors of a poor outcome (2). She was treated with IVIG on day 8 of illness due to a misdiagnosis we speculate that this may have contributed to her complete recovery from RMSF. RMSF is a vasculitis and IVIG therapy may be warranted in patients who have late presentation and particularly in patients with shock or neurological changes during their course. It is unknown if IVIG therapy given later in the course of treatment of patients with severe RMSF vasculitis would have a similar benefit. Perhaps, as with Kawasaki disease, early treatment shows the most benefit. The potential use of IVIG as a treatment in RMSF as well as the timing of therapy warrants further