Kushawaha Anurag, Brown Mark, Martin Ismael, Evenhuis Walther
Division of Hospital Medicine, Department of Internal Medicine, Naples Community Hospital, Florida, USA.
BMJ Case Rep. 2013 Jan 11;2013:bcr2012007155. doi: 10.1136/bcr-2012-007155.
Rocky Mountain spotted fever (RMSF) is a serious tick-borne illness caused by Rickettsia rickettsii that is endemic in southeastern USA. Although RMSF has been described as causing the classic clinical triad of fever, headache and a characteristic rash, serious and potentially life-threatening manifestations can occur. Cardiopulmonary involvement, although infrequent, may occur with severe cases of RMSF. Rickettsial myocarditis is an uncommon occurrence. We present a case of a previously healthy 26-year-old man, who was hitch-hiking across the southeastern USA, with serologically proven RMSF causing adult respiratory distress syndrome, septic shock and myocarditis manifested by elevated cardiac enzymes and decrease in myocardial function. After treatment with antibiotics, the myocarditis resolved. Therefore, although unusual, clinicians should be aware of possible myocardial involvement in patients with appropriate tick-exposure histories or other clinical signs of RMSF.
落基山斑疹热（RMSF）是一种由立氏立克次体引起的严重蜱传疾病，在美国东南部地区流行。尽管RMSF被描述为会引发发热、头痛和特征性皮疹这一典型临床三联征，但也可能出现严重且潜在危及生命的表现。心肺受累情况虽不常见，但在重症RMSF病例中可能发生。立克次体心肌炎并不常见。我们报告一例病例，一名既往健康的26岁男性，在美国东南部搭便车旅行，血清学证实患有RMSF，导致成人呼吸窘迫综合征、感染性休克和心肌炎，表现为心肌酶升高和心肌功能下降。经抗生素治疗后，心肌炎得以缓解。因此，尽管不常见，但临床医生应意识到，对于有适当蜱虫暴露史或其他RMSF临床体征的患者，可能存在心肌受累情况。
