RICKETTSIA MASQUERADING AS THROMBOTIC THROMBOCYTOPENIC PURPURA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Rocky Mountain spotted fever (RMSF), a tick-borne illness, and Spotted Rickettsiosis, presents with nonspecific symptoms (e.g., high fever, headache, myalgia) mortality rate in the pre-antibiotic era (20-80%) (1,2). We present patient who developed thrombotic thrombocytopenic purpura (TTP) PLASMIC SCORE: 6 points. CASE PRESENTATION: A 47-year-old male no significant past medical history presented to hospital altered mental status. His brother reported that patient's started 10 days before presentation when chills shivering. He continued subsequently severe headache chest pain, abdominal pain. Physical exam revealed jaundice scleral icterus. However, presence of rash. The lives rural area where stray cats, dogs, cattle were common allowed inside house.bLaboratories white blood cell count (WBC) 15.4× 109/L, hemoglobin 13.4 g/dl, platelet 20 × 109/L. peripheral smear taken upon admission was unremarkable evidence microangiopathic hemolytic anemia. subsequent showed MAHA marked thrombocytopenia. result immunofluorescence antibody testing for rickettsia immunoglobulin G M strongly positive Flea-borne (murine) typhus.Our treated doxycycline admitted ICU due illness. Throughout hospitalization, improve, his complete resolution features disseminated intravascular coagulation discharged after 4 course oral DISCUSSION: Fever is an infectious diseasecaused by Rickettsia ricketsii. Tickborne rickettsial diseases United States have rise, resulting illness death individuals prior comorbid conditions, despite widely available effective antibacterial therapy. early signs tickborne illnesses symptoms; therefore, RMSF can oftentimes be misdiagnosed as acute viral syndrome, or our case, TTP (3). Furthermore, while this disease often associated classic triad rash, tick bite, only minority cases these initial symptoms. Clinicians should include infection diagnostic workup any pentad (TTP). CONCLUSIONS: This case illustrates importance infections differential diagnosis patients febrile With delay treatment, progress rapidly neurologic manifestations, renal failure, thrombocytopenia, death. REFERENCE #1: Parola P, Paddock CD, Socolovschi C, et al. Update on rickettsioses around world: geographic approach. Clin Microbiol Rev. 2013;26(4):657-702. doi:10.1128/CMR.00032-13 #2: Weerakoon K, Kularatne SA, Rajapakse J, Adikari S, Waduge R. Cutaneous manifestations Central Province Sri Lanka: descriptive study. PLoS Negl Trop Dis. 2014;8(9):e3179. doi:10.1371/journal.pntd.0003179 #3: Booth KK, Terrell DR, Vesely SK, George JN. Systemic mimicking purpura. Am J Hematol. 2011;86(9):743-51. doi:10.1002/ajh.22091 DISCLOSURES: No relevant relationships Jose Campo Maldonado, source=Web Response Lily Chen, Cesar Peralta,