Rickettsial diseases in Brazil: report of a case with varicella-like skin lesions*

An Bras Dermatol. 2017;92(5):740-50. Dear editor, A 66-year-old male patient began to experience headache, fever, myalgia, and general malaise three days after returning from a farmhouse in São Sebastião do Paraiso, in the state of Minas Gerais, Brazil, where he stayed for five days. After five days, the patient reported cough, dyspnea, diarrhea, and rash, and was hospitalized for evaluation. Physical examination showed a BP of 130x80 mmHg, HR of 100 BPM, RR of 21 IPM, temperature of 38.5°C, O2 Sat of 90% in ambient air, and O2 Sat of 94 % with 3L/min via nasal cannulae. The patient was in regular state and tachypneic. Respiratory auscultation showed bilateral crepitation. Dermatological examination revealed erythematous macules, papules, vesicles, pustules, and vesiculo-crusted lesions on the trunk, back, and in the cervical region. We also observed an erythematous papule topped by a vesicle showing a necrotic spot in the right scapular region (Figure 1). Chest x-ray performed on the third day of his symptoms revealed bilatFlávia da Silva Domingos Santos1 Carla Cristina Alves Mantovam1 Rafael Diniz Duarte1 Antônio Manzano Leite de Oliveira2 Fred Bernardes Filho1,3 t