Rocky Mountain Spotted Fever–Associated Myocarditis

A previously healthy 23-year-old enlisted man presented for 2 days of fever, gastrointestinal symptoms, cough, and disseminated rash involving the palms and soles. Initial evaluation revealed leukocytosis, elevated liver enzymes, and hyponatremia. Despite antibiotic therapy for pneumonia, his condit...

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Main Authors: Camily Morales Lopez, Eric C. Zuberi, Michael A. Acevedo Monsanto, Libardo Rueda Prada, Melissa P. Cortes
Format: Article
Language:English
Published: American College of Physicians 2025-06-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2025.0141
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author Camily Morales Lopez
Eric C. Zuberi
Michael A. Acevedo Monsanto
Libardo Rueda Prada
Melissa P. Cortes
author_facet Camily Morales Lopez
Eric C. Zuberi
Michael A. Acevedo Monsanto
Libardo Rueda Prada
Melissa P. Cortes
author_sort Camily Morales Lopez
collection DOAJ
description A previously healthy 23-year-old enlisted man presented for 2 days of fever, gastrointestinal symptoms, cough, and disseminated rash involving the palms and soles. Initial evaluation revealed leukocytosis, elevated liver enzymes, and hyponatremia. Despite antibiotic therapy for pneumonia, his condition worsened, with development of bilateral pleural effusions and myocarditis. After treatment with doxycycline, methylprednisolone, and furosemide, his symptoms improved. He completed a 7-day antibiotic course. Rocky Mountain spotted fever serology was positive 5 weeks after symptom onset. This case highlights the importance of maintaining a broad differential diagnosis and remaining vigilant for atypical presentations of infections to prevent life-threatening complications.
format Article
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institution DOAJ
issn 2767-7664
language English
publishDate 2025-06-01
publisher American College of Physicians
record_format Article
series Annals of Internal Medicine: Clinical Cases
spelling doaj-art-aff71fc64e434889a399cfd36ed049bd2025-08-20T03:21:34ZengAmerican College of PhysiciansAnnals of Internal Medicine: Clinical Cases2767-76642025-06-014610.7326/aimcc.2025.0141Rocky Mountain Spotted Fever–Associated MyocarditisCamily Morales Lopez0Eric C. Zuberi1Michael A. Acevedo Monsanto2Libardo Rueda Prada3Melissa P. Cortes41Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida1Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida1Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida1Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida1Department of Internal Medicine, Mayo Clinic, Jacksonville, FloridaA previously healthy 23-year-old enlisted man presented for 2 days of fever, gastrointestinal symptoms, cough, and disseminated rash involving the palms and soles. Initial evaluation revealed leukocytosis, elevated liver enzymes, and hyponatremia. Despite antibiotic therapy for pneumonia, his condition worsened, with development of bilateral pleural effusions and myocarditis. After treatment with doxycycline, methylprednisolone, and furosemide, his symptoms improved. He completed a 7-day antibiotic course. Rocky Mountain spotted fever serology was positive 5 weeks after symptom onset. This case highlights the importance of maintaining a broad differential diagnosis and remaining vigilant for atypical presentations of infections to prevent life-threatening complications.https://www.acpjournals.org/doi/10.7326/aimcc.2025.0141
spellingShingle Camily Morales Lopez
Eric C. Zuberi
Michael A. Acevedo Monsanto
Libardo Rueda Prada
Melissa P. Cortes
Rocky Mountain Spotted Fever–Associated Myocarditis
Annals of Internal Medicine: Clinical Cases
title Rocky Mountain Spotted Fever–Associated Myocarditis
title_full Rocky Mountain Spotted Fever–Associated Myocarditis
title_fullStr Rocky Mountain Spotted Fever–Associated Myocarditis
title_full_unstemmed Rocky Mountain Spotted Fever–Associated Myocarditis
title_short Rocky Mountain Spotted Fever–Associated Myocarditis
title_sort rocky mountain spotted fever associated myocarditis
url https://www.acpjournals.org/doi/10.7326/aimcc.2025.0141
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AT ericczuberi rockymountainspottedfeverassociatedmyocarditis
AT michaelaacevedomonsanto rockymountainspottedfeverassociatedmyocarditis
AT libardoruedaprada rockymountainspottedfeverassociatedmyocarditis
AT melissapcortes rockymountainspottedfeverassociatedmyocarditis