Rocky Mountain spotted fever differential diagnosis

Overview
In virtually all cases, Rocky Mountain spotted fever presents with a rash. When trying to differentiate RMSF with other infections, it should be noted that there has been a rare case in which RMSF has presented without the typical rash.

Case Study
A crucial piece of the Rocky Mountain spotted fever puzzle has to do with making an early diagnosis, which can prove very difficult at times. It can be especially difficult when a patient doesn't present with the symptoms normally associated with the specific infection. A rare symptom of RMSF is severe rhabdomyolysis in which all of the known cases present with an accompanying rash. There was an unusual case that presented a young male who has severe rhabdomyolysis without an accompanying rash.

===Presentation of 16 year old male .===
 * Hospitalized for 4 days with high fever
 * Gastrointestinal symptoms for 2 days
 * Severe pain in lower extremities
 * Walking became difficult
 * No history of
 * Tick bite
 * Travel
 * Sick contact
 * No rash but extreme tenderness in both thighs
 * Motor testing was limited (due to pain)
 * Neurological testing was normal

===Laboratory findings .===
 * Thrombocytopenia
 * Hyponatremia
 * Elevated liver enzymes.
 * Elevated C reactive protein.
 * Myoglobinuria shown in urinalysis
 * CPK levels up to 19,915 (very high)
 * Concentrations for RMSF were positive which confirmed the diagnosis.

Conclusion .

 * Doxycycline was the treatment of choice for 10 days
 * Patient was afebrile after 3 days
 * Patient began walking after a week
 * RMSF should be considered as a possible diagnosis even if a rash is not present. It can be considered a rare cause of severe rhabdomyolysis after common causes have been sufficiently ruled out.