Walker D H, Lesesne H R, Varma V A, Thacker W C
Arch Intern Med. 1985 Dec;145(12):2194-6.
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.
落基山斑疹热可能主要表现为腹部症状，包括恶心、呕吐、腹泻和腹痛。两名老年患者出现急性发热性疾病和腹部症状。最初没有皮疹。检查发现其中一名患者有胆结石，另一名患者经超声检查发现胆囊壁增厚，周围有一无回声区，提示有胆囊周围脓肿。两名患者均接受了急诊剖腹手术，两人都进行了胆囊切除术，其中一人还进行了阑尾切除术。两名患者均在术后数天死亡。后来复查病理标本显示，胆囊和阑尾的多条血管感染了立氏立克次体，并有局灶性血管血栓形成和出血。这些记录在案的腹部内脏血管立克次体直接感染和病变提示了落基山斑疹热腹部症状的基础。
