Rocky Mountain spotted fever is a tick-borne illness that is prevalent in the south and the central United States, primarily during the summer months. Patients with delayed diagnosis can experience increased mortality and morbidity, particularly poor neurological outcome. We present a case of a 7-year-old girl with
Rocky Mountain spotted fever who was admitted with severe neurological changes and
septic shock on day 8 of illness. She was initially diagnosed with
Kawasaki disease and treated with
intravenous immunoglobulin. Her treatment also included
doxycycline,
vancomycin, and
ceftriaxone due to concerns regarding
Rocky Mountain spotted fever and bacterial
sepsis. During hospitalization, the patient required
mechanical ventilation for respiratory distress, inotropic support, and fluid
resuscitation for
hypotension. Titers for
Rocky Mountain spotted fever were ultimately positive, with magnetic resonance imaging of the brain demonstrating numerous punctate foci of restricted diffusion within the supratentorium, including the corpus callosum and basal ganglia. Although the patient presented late in the disease course, she ultimately had a good neurological outcome. We theorized that administration of
intravenous immunoglobulin prevented ongoing neurological
injuries from the
cerebral vasculitis, which are associated with
Rocky Mountain spotted fever.