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David H. Walker, MD; Henry R. Lesesne, MD; V. A. Varma, MD; W. C. Thacker, MD

Arch Intern Med. 1985;145(12):2194-2196.

Abstract
• Rocky Mountain spotted fever can present with predominantly abdominal symptoms including nausea, vomiting, diarrhea, and abdominal pain. Two elderly patients presented with an acute febrile illness and abdominal symptoms. Rash was not present initially. Workup disclosed cholelithiasis in one, and a thickened gallbladder wall surrounded by a sonolucent zone suggesting a pericholecystic abscess was found by ultrasonography in the other. Both patients underwent emergency laparotomy, with cholecystectomy in both and appendectomy in one. Both patients died several days postoperatively. Pathologic specimens reviewed later showed that multiple blood vessels of the gallbladder and the appendix were infected with Rickettsia rickettsii, and there was focal vascular thrombosis and hemorrhage. These documented direct rickettsial infections and lesions in the blood vessels of abdominal viscera suggest the basis for the abdominal symptoms in Rocky Mountain spotted fever.

(Arch Intern Med 1985;145:2194-2196)

Author Affiliations
From the Departments of Pathology and Medicine, University of North Carolina School of Medicine, Chapel Hill (Drs Walker and Lesesne); Rutherford Hospital, Rutherfordton, NC (Dr Varma); and Laughlin Memorial Hospital, Greeneville, Tenn (Dr Thacker).

Footnotes
Accepted for publication Jan 16, 1985.

Reprint requests to Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27514 (Dr Walker).

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