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Abstract Details

Rocky Mountain spotted fever presenting with meningoencephalitis and bilateral abducens nerve palsies
Infectious Disease
P11 - Poster Session 11 (8:00 AM-9:00 AM)
13-018
To present the case of a 19-year-old woman presenting with meningoencephalitis and bilateral abducens nerve palsies secondary to Rocky Mountain spotted fever, and to review the neurological manifestations, diagnosis, and management of the disease.
Rocky Mountain spotted fever, a disease caused by tick-borne infection with Rickettsia rickettsii, is a treatable but often under-recognized consideration in the differential diagnosis of an acute febrile illness. It may present with meningoencephalitis and focal neurological signs. Prompt initiation of antibiotic therapy is essential and therefore it is important to recognize the various ways in which the disease can manifest.
Case report
A 19-year-old woman presented with fever, headache, neck stiffness, rash, altered mental status, and blurred vision. On examination, she had bilateral inward deviation of the eyes with restriction of abduction. There was no evidence of papilledema. She was started on empiric treatment for meningitis. A lumbar puncture was done and cerebrospinal fluid studies were notable for lymphocytic pleocytosis and elevated protein. Serology for Rickettsia rickettsia was strongly reactive with IgG>1:1024 and IgM>1:256. She completed a course of doxycycline with complete resolution of her headache and fever and normalization of her mental status.
Early diagnosis of Rocky Mountain spotted fever can be challenging. Central nervous system involvement is a serious complication and tends to occur late in the disease course. Cranial nerve palsies can be associated with rickettsial infections in the absence of raised intracranial pressure. Diagnosis is confirmed with serology, but treatment should be initiated as soon as the diagnosis is suspected. Doxycycline is the antibiotic of choice.
Authors/Disclosures
Melissa Ng, MB BChir
PRESENTER 		Dr. Ng has nothing to disclose.
No disclosure on file
No disclosure on file