51-YO🧔♂️alcoholic homeless living with dog in southern France: fever, confusión, a maculopapular rash on the trunk (A), hypotension, disorientation, an eschar on his right shoulder (B), & several tiny black spots
Platelet:⬇️
AST, ALT, GGT, LDH:⬆️
1/
doi.org/10.1086/420747
#MedEd
Platelet:⬇️
AST, ALT, GGT, LDH:⬆️
1/
doi.org/10.1086/420747
#MedEd
Careful examination: these spots were actually #ticks (a total of 22) attached on the skin; they were removed
During 25 h, he was examined by diferente doctors. Dermatologic examination was woefully incomplete, as often occurs when unhygienic, homeless, &/or drunken patients
2/
During 25 h, he was examined by diferente doctors. Dermatologic examination was woefully incomplete, as often occurs when unhygienic, homeless, &/or drunken patients
2/
All ticks were identified as #Rhipicephalus sanguineus, the brown dog tick, including 1 female (A) and nymphs (B).
MEDITERRANEAN SPOTTED FEVER IN ITS MALIGNANT FORM
3/
doi.org/10.1086/420751
#IDtwitter #dermatolgy
MEDITERRANEAN SPOTTED FEVER IN ITS MALIGNANT FORM
3/
doi.org/10.1086/420751
#IDtwitter #dermatolgy
Empirical treatment with doxycycline and ciprofloxacin was started.
The patient's condition deteriorated, and he died 10 h later.
4/
The patient's condition deteriorated, and he died 10 h later.
4/
Blood & biopsy escare culture:➕positive for Rickettsia conorii, the agent of MEDITERRANEAN SPOTTED FEVER
R. conorii DNA from a specimen of the spleen: ➕
1 of the 22 ticks: ➕for R. conorii by molecular methods and shell-vial cell culture
5/
#dermatology #microbiology
R. conorii DNA from a specimen of the spleen: ➕
1 of the 22 ticks: ➕for R. conorii by molecular methods and shell-vial cell culture
5/
#dermatology #microbiology
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