5 year male aaparently asymptomatic 4 days back. h/o fever 4 days, vasculitic rash and acral gangrene for 2 days. peripheral pulses well felt bilateral upper nd lower limbs.chelitis present.systemic examn normal.no history of drug intake. Diagnosis?

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plz do not harp on ricketsial fever ,its one of differential but it looks lower on card considering duration of illness .small vessel vasculitis and encephalopathy are common c tick borne spotted fever on Second week.In first WK they r treated as measles like illness.rest all types of ricketsial illness present c fever c rash.

it can be small vessel vasculitis D/D staph scalded skin syndrome. or HSP further vasulitic workup including c anca p anca suggested and skin biopsy might be helpful.. v have seen HSP presenting like this.. plus appropriate antibiotic coverage will help..

this is small vessel vasculitis .in view of purpura fulminans meningococcemia looks more likely, ricketsial fever is other differential.

Ricketsiosis ,Iv chloramphenicol,in older kids Doxycyline very effective

Does fit in criteria of kawasaki rickettisial other differential

dengue like fever with vascular collapse

Dx rickettsia work up

do Rickettsia work up

meningococcemia.

hemodynamically stable.no signs of shock
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I beg to differ,u may not get a classical fever with rash ,u need to hv a high index of suspicion.Get a Weil Felix done and serology done.What r the CSF findings n other test results,plz update.They may just present as PUO with spikes as high as 108 with mild TCP ,loose motions ,conjunctival congestion n hsmegaly.if u get a consistent clinical picture n non response to routine management,do a Weil felix which if positive err on the side of treating.

weil Felix is very non specific. l do practice in marathwada,by en large we see almost 100 odd pt every yr in monsoon c various presentation. might be wat ever I told may not be written in book but its regular illness which we treat its clinically diagnosed ,no need for any blood test,CSF is usually normal,its encephalopathy.
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