Abstract

THE NUMBER of reported cases of Rocky Mountain spotted fever (RMSF) in the United States has increased from 204 cases in 1960 to 979 cases in 1982. The South Atlantic states accounted for 521 (53%) of the reported cases in 1982 and North Carolina had the highest RMSF infection rate.1 Texas had 64 reported cases during the same period but was considered to be a nonendemic area for RMSF (J. P. Taylor and T. G. Betz, Texas Department of Health, written communication, Aug 15, 1983). Ninety-five percent of the patients became ill between April 1 and Sept 30.1 Thus, when a patient has the classical features of fever, rash, and history of tick exposure in an endemic area between the months of April and September the physician should consider RMSF as a diagnostic possibility. On the other hand, atypical manifestations in nonendemic areas could lead to an erroneous diagnosis and a delay in the initiation of appropriate therapy, with consequent increases in complications and mortality. Recent reports indicate that patients who die of this infection manifest a protean illness causing dysfunction of multiple organ systems.2–4 In particular, patients with central nervous system involvement and/or renal failure have a very poor prognosis.5 I report the unusual case of a patient in southeastern Texas who had RMSF with atypical manifestations and viscerotropic complications, and who survived after receiving appropriate antibiotic therapy eight days after onset of symptoms.