Question

A 16 y.o. girl presents to the ED in May complaining of a rash and fever. She lives near the woods in North Carolina but is unsure whether she was bitten by a tick. She feels nauseous and "aches all over." PE shows a 38.3oC (101oF) and a petechial rash over her ankles and palms of her hands. Which of the following is the next step in management of this patient?

A)Discharge her with a follow-up with her healthcare provider; Advise her that this condition is viral.
B)Admit to hospital; Order IV ceftriaxone
C)Prescribe azithromycin and send her home.
D)Administer doxycycline and admit to hospital
E)Obtain a stat creatinine phosphokinase (CPK) level

Answer 1

The patient should be admitted to the hospital and treated with IV ceftriaxone, as her symptoms are consistent with Rocky Mountain Spotted Fever, a serious and potentially fatal condition if untreated.

Step-by-step explanation:

A 16-year-old girl presenting with a fever and a petechial rash over her ankles and palms in North Carolina, after possibly being bitten by a tick, is suggestive of Rocky Mountain Spotted Fever (RMSF). The next step in management, after recognizing the signs and symptoms consistent with a tickborne rickettsial disease, would be admitting the patient to the hospital and ordering IV ceftriaxone (Option B). Early treatment is critical for RMSF as it can be fatal if left untreated; specifically, one should not wait for the appearance of petechiae to initiate treatment, as this can be a sign of progression to severe disease. Doxycycline is also an appropriate treatment for RMSF, especially in non-pregnant patients, and could be considered as an alternative to ceftriaxone.