I read with interest the article on Rocky Mountain spotted fever (RMSF) by Masters et al1 that recently appeared in the ARCHIVES. The authors emphasized pitfalls in the diagnosis and treatment of RMSF, which are important for clinicians. As a review article, I believe several important clinical points were omitted.
The 2 cases presented in the article were not those of the authors and were of young children initially diagnosed as having a "viral syndrome." It is hard to understand how these cases could have been dismissed as viral. There are virtually no other infectious diseases that present initially with macules on the wrists and/or ankles and also involve the palms and/or soles. Enteroviral diseases of summer do not have the same distribution. Similarly, the mild increase in serum transaminases should have been another clue that the patients simply did not have a "viral syndrome," particularly when it occurs in summer in a febrile patient with a macular rash on the wrists and/or soles. Dismissing these patients as having viral gastroenteritis simply because they had diarrhea is also another pitfall. Excluding RMSF, no infection presenting with diarrhea is accompanied by a mild increase in serum transaminases, and the characteristic wrist and/or ankle rash of RMSF.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.