Rocky Mountain spotted fever (RMSF) is an acute, serious tick borne illness caused by Rickettsia rickettsi. Frequently, RMSF is manifested by headache, a typical rash and fever but atypical disease is common, making diagnosis difficult. Inflammatory arthritis as a manifestation is rare. The purpose of this study is to describe a patient with serologically proven RMSF who presented in an atypical manner with inflammatory arthritis of the small joints of the hands and to review the previously reported patients with rickettsial infection and inflammatory arthritis.
An 18-year-old woman presented with a rash that began on the distal extremities and spread centrally, along with hand pain and swelling. She had tenderness and swelling of the metacarpophlangeal joints on examination in addition to an erythematosus macular rash and occasional fever.
Acute and convalescent serology demonstrated R rickettsi infection. She was successfully treated with doxycycline. Conclusions: Inflammatory arthritis is a rare manifestation of RMSF or other rickettsial infection with 8 previously reported patients, only 1 of whom had RMSF. Physician must have a high index of suspicion for RMSF because of atypical presentations.
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- What’s new in Rocky Mountain spotted fever?.Infect Dis Clinic N Am. 2008; 22: 415-432
- Rocky Mountain spotted fever.Lancet Infect Dis. 2007; 7: 724-732
- Rocky Mountain spotted fever.A clinical review based on 48 confirmed cases, 1943-1986. Medicine. 1990; 69: 35-45
- Some observations on the so-called spotted fever of Idaho.Med Sentinel. 1899; 7: 433-438
- The study of “Rocky Mountain spotted fever” (tick fever?) by means of animal inoculations.A preliminary communication. JAMA. 1906; 47: 33-36
- Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis—United States: a practical guide for physicians and other health-care and public health professionals.MMWR Recomm Rep. 2006; 55: 1-27
- Rocky Mountain spotted fever.Clin Dermatol. 1996; 14: 245-258
- Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases.J Infect Dis. 1984; 150: 480-488
- Fever and rash in a 3-year-old girl: Rocky Mountain spotted fever.Cutis. 2002; 70: 165-168
- Dermatologic manifestations of arthropod borne diseases.Infect Dis Clin North Am. 1994; 8: 689-712
- Rocky Mountain “spotless” and “almost spotless” fever: a wolf in sheep’s clothing.Clin Infect Dis. 1992; 15: 439-448
- Mediterranean boutonneuse fever as a cause of arthritis and false-positive serology for Borrelia burgdorferi.Rev Clin Esp. 1993; 192: 73-75
- Arthritis in Israeli spotted fever.Clin Rheumatol. 1995; 14: 580-581
- Rickettsioses presenting as major joint arthritis and erythema nodosum: description of four patients.Clin Rheumatol. 2009; 28: 867-868
- Acute suppurative arthritis: an unusual manifestation of murine typhus (endemic).Med Clin. 1991; 97: 142-143
- Arthritis in Mediterranean spotted fever.An immune complex mediated synovitis. Br J Rheumatol. 1993; 32: 642-643
- Rocky Mountain spotted fever.Clin Infect Dis. 1998; 27: 1353-1359
- Action of antibiotics on Rickettsia rickettsia.J Infect Dis. 1986; 153: 626-628
- Fatal human infection with Rickettsia rickettsii, Yucatan, Mexico.Emerg Infect Dis. 2006; 12: 672-674
Accepted: April 5, 2013
Received: December 15, 2012
The authors have no financial or other conflicts of interest to disclose.
© 2013 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.