Boutonneuse fever in a child: a case report and overview
Ahuja, S.R.; Karande, S.; Naik, S.; Kulkarni, M.; Ahuza, S.R.
Journal of the Indian Medical Association 102(3): 170
2004
ISSN/ISBN: 0019-5847 PMID: 15473280 Document Number: 566685
A five and a half year-old boy from Mumbai, India presented with an acute febrile illness associated with abdominal pain, generalized myalgia, arthralgia and skin rash. An elder sibling had a similar illness and expired three days back. Initially crystalline penicillin and chloramphenicol were started. Investigations to diagnose the cause of fever viz., peripheral blood smear for malarial parasite, blood and urine cultures, Widal test and dot-ELISA for leptospirosis were negative. Weil-Felix test revealed a positive OX-2 titre of 1:100. Retrospectively, a history of close contact with dogs was elicited and a tick bite mark on the hand detected. Within five days of antibiotic therapy the fever resolved. Chloramphenicol was given totally for two weeks and the child recovered fully. Rickettsial infection should be considered in a child presenting with an acute febrile illness with skin rash since the response to specific antimicrobial therapy is dramatic and life-saving.