Our patient's initial presentation seemed classic--diurnal high spiking fevers, macular rash
, joint pain, and anorexia," Ms.
Additionally, he had an erythematous macular rash
in a malar distribution and oily, flaky, white to yellowish scales on his face and chest.
Physical examination noted conjunctival suffusion, epistaxis, posterior cervical and inguinal lymphadenopathy, bilaterally diminished breath sounds, rhonchi and crackles, bloody cough, tachycardia, hepatosplenomegaly, and a macular rash
over the lower extremities.
Characterized by fever and a macular rash
in its early stages, untreated RMSF can result in severe systemic manifestations, including pneumonitis, myocarditis, hepatitis, acute renal failure, encephalitis, gangrene, and death.