Download PDF
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.
› Further Information
Also available at
   Permissions and Reprints

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/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dantas-Torres F. Rocky Mountain spotted fever. Lancet Infect Dis 2007; 7 (11) 724-732
    CrossrefPubMedGoogle Scholar
  • 2 Chapman AS. Diagnosis and management of tickborne rickettsial diseases; Rocky Mountain spotted fever, ehrlichioses, and anaplasmosis–United States: a practical guide for physicians and other health-care and public health professional. 2006 . Available at: https://stacks.cdc.gov/view/cdc/6709
    PubMedGoogle Scholar
  • 3 Stallings SP. Rocky Mountain spotted fever and pregnancy: a case report and review of the literature. Obstet Gynecol Surv 2001; 56 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 4 Gallis HA, Agner RC, Painter CJ. Rocky Mountain spotted fever in pregnancy. N C Med J 1984; 45 (03) 187-188
    PubMedGoogle Scholar
  • 5 Markley KC, Levine AB, Chan Y. Rocky Mountain spotted fever in pregnancy. Obstet Gynecol 1998; 91 (5 Pt 2): 860
    PubMedGoogle Scholar
  • 6 Licona-Enriquez JD, Delgado-de la Mora J, Paddock CD, Ramirez-Rodriguez CA, Candia-Plata MDC, Hernández GÁ. Rocky Mountain spotted fever and pregnancy: four cases from Sonora, Mexico. Am J Trop Med Hyg 2017; 97 (03) 795-798
    CrossrefPubMedGoogle Scholar
  • 7 Tribaldos M, Zaldivar Y, Bermudez S. et al. Rocky Mountain spotted fever in Panama: a cluster description. J Infect Dev Ctries 2011; 5 (10) 737-741
    CrossrefPubMedGoogle Scholar
  • 8 de Lemos ER, Alvarenga FB, Cintra ML. et al. Spotted fever in Brazil: a seroepidemiological study and description of clinical cases in an endemic area in the state of São Paulo. Am J Trop Med Hyg 2001; 65 (04) 329-334
    CrossrefPubMedGoogle Scholar
  • 9 Welch KJ, Rumley RL, Levine JA. False-positive results in serologic tests for Rocky Mountain spotted fever during pregnancy. South Med J 1991; 84 (03) 307-311
    CrossrefPubMedGoogle Scholar
  • 10 Hidalgo M, Orejuela L, Fuya P. et al. Rocky Mountain spotted fever, Colombia. Emerg Infect Dis 2007; 13 (07) 1058-1060
    CrossrefPubMedGoogle Scholar
  • 11 Cross R, Ling C, Day NPJ, McGready R, Paris DH. Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation?. Expert Opin Drug Saf 2016; 15 (03) 367-382
    CrossrefPubMedGoogle Scholar
  • 12 Herbert WN, Seeds JW, Koontz WL, Cefalo RC. Rocky Mountain spotted fever in pregnancy: differential diagnosis and treatment. South Med J 1982; 75 (09) 1063-1066
    CrossrefPubMedGoogle Scholar