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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(01): e40-e42
DOI: 10.1055/s-0043-1778118
Case Report

Atypical Presentation of Rocky Mountain Spotted Fever in Pregnancy

Jenny Wu 
1   Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
,
Sarah K. Dotters-Katz
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
,
Megan Varvoutis
2   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina
› Author Affiliations Funding None.
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Abstract

Rocky Mountain spotted fever (RMSF) is a common tick-borne disease and can have variable presentation with potentially fatal outcomes when untreated. We describe an atypical presentation of RMSF in the third trimester. A 37-year-old multiparous woman at 310/7 weeks' gestation presented normotensive with headaches and fever but no rash or significant tick exposure. She was initially treated for atypical hemolysis, elevated liver enzymes, and low platelet count syndrome but further decompensated, requiring intensive care unit transfer, intubation, and emergent delivery. Doxycycline administration was associated with marked improvement with no significant sequalae to mother or infant. Later convalescent serologies were positive for RMSF. RMSF is a clinically challenging diagnosis in pregnancy. Given significant morbidity and mortality associated with delayed treatment, high suspicion in endemic areas is needed, and prompt antibiotic use with doxycycline should be administered.

Keywords

Rocky Mountain spotted fever - pregnancy - tick-borne - infections - doxycycline


Publication History

Received: 20 May 2020

Accepted: 22 October 2023

Article published online:
23 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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