Abstract
BackgroundSpotted fever group rickettsioses (SFGR) transmitted mostly by ticks are increasingly discovered around the World and some of them are either re-emerging or emerging in Sri Lanka. Accidental human infections caused by these vector borne zoonotic diseases generally give rise to nonspecific acute febrile illnesses which can be complicated by multi organ involvement carrying high morbidity and mortality. Nonspecific clinical features and non-availability of early diagnostic facilities are known to result in delay in the diagnosis of rickettsial infections. Therefore, awareness of their prevalence and more importantly their clinical features would be help in the early diagnosis and institution of appropriate therapy.Case presentationA 39-year-old otherwise healthy female presented with an acute febrile illness complicated by severe small joint and large joint arthritis, jaundice, acute kidney injury and disseminated intravascular coagulation (DIC) mimicking palindromic rheumatism or severe sepsis. She later developed a widespread fern-leaf pattern necrotic skin rash with evidence of vasculitis on the palms and soles, aiding the clinical diagnosis of SFGR. She had very high antibody titres against R. conorii antigen confirming the diagnosis and recovered completely with anti-rickettsial therapy.ConclusionWe feel that clinicians should be aware of the unusual clinical presentations such as purpura fulminans and ‘fern-leaf’ pattern necrotic skin rash of SFGR infection. Such knowledge would not only benefit those who practice in tropics with limited diagnostic facilities but also would improve the management of acute febrile illness in returning travelers who visit endemic areas.
Highlights
Spotted fever group rickettsioses (SFGR) transmitted mostly by ticks are increasingly discovered around the World and some of them are either re-emerging or emerging in Sri Lanka
We feel that clinicians should be aware of the unusual clinical presentations such as purpura fulminans and ‘fern-leaf’ pattern necrotic skin rash of SFGR infection
Such knowledge would benefit those who practice in tropics with limited diagnostic facilities and would improve the management of acute febrile illness in returning travelers who visit endemic areas
Summary
Spotted fever group rickettsioses (SFGR) transmitted mostly by ticks are increasingly discovered around the World and some of them are either re-emerging or emerging in Sri Lanka. Case presentation: A 39-year-old otherwise healthy female presented with an acute febrile illness complicated by severe small joint and large joint arthritis, jaundice, acute kidney injury and disseminated intravascular coagulation (DIC) mimicking palindromic rheumatism or severe sepsis She later developed a widespread fern-leaf pattern necrotic skin rash with evidence of vasculitis on the palms and soles, aiding the clinical diagnosis of SFGR. Since the use of molecular tools for detection, human pathogenic species of SFGR are increasingly described [1] While most of these organisms are transmitted by ticks and in some cases by mites that generally feed on wild or domestic animals, the infection in human is accidental [2]. SFGR was described less commonly in the Western province of Sri Lanka, in a hospital based study where patient recruitment had been on strict inclusion criteria [5], with the establishment of Indirect Immunofluorescence antibody (IFA) based diagnostics it became apparent that SFGR are
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