Kamsi
Forum Guru
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Posts: 347
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A 21-year-old man with no significant past medical history comes to the physician complaining
of a 4-day history of fevers, chills, severe headache, and diffuse aches and pains. He denies
cough. After approximately 48 hours with these symptoms, he developed a rash on the palms
of his hands and the soles of his feet and on his wrists and ankles. Over the next 48 hours, the
rash began to spread to his arms, legs, and trunk. The rash also changed from maculopapular
in nature to petechial. He recently returned from a camping trip to several Western states
where he believes he was bitten by two ticks. Physical examination reveals a moderately
"toxic" appearing man. His temperature is 39.0 C (102.3 F), blood pressure is 110/60 mm Hg,
pulse is 113/min, and respirations are 15/min. He has a diffuse rash on his body, including his
hands and feet as shown. He does not have photophobia or nuchal rigidity. His heart is
tachycardic without murmurs. The remainder of his physical examination is unremarkable.
Laboratory results reveal a normal white count and liver function studies. Which of the
following is the most likely pathogen?
A. Bartonella henselae
B. Borrelia burgdorferi
C. Coxiella burnetii
D. Ehrlichia chaffeensis
E. Rickettsia rickettsii
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| Ivonne
Forum Guru
Topics: 51
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Rash in palms and soles reminds me RMSF or 2ry syphilis:
(E)
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| kpmle2
Forum Elite
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E. Rickettsia rickettsii
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| elitoki
Forum Guru
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E 
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| peraspera
Forum Elite
Topics: 38
Posts: 233
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Rocky Mountain spotted fever, the rush from palms & soles up to trunk.
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