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A new study in Emerging Infections Diseases describes 5 children who had Rocky Mountain spotted fever (RMSF) and manifested clinical symptoms similar to multisystem inflammatory syndrome (MIS-C) in Mexico. Although the number of cases was small, it may be an important differential because Rocky Mountain spotted fever can progress rapidly to death or severe illness if appropriate antimicrobial drug therapy is not delivered within the first 5 days after illness onset. Among the 5 cases, the median patient age was 8 years (range 6–17), and the median duration from illness onset to hospital admission was 10 days.

New considerations: Authors note that clinical teams should consider RMSF in the differential diagnoses of patients with MIS-C because RMSF and MIS-C share clinical and laboratory test abnormalities “and distinguishing between those 2 conditions can be challenging.” MIS-C can also be confused with incomplete Kawasaki Disease. Discover more in the JUCM archives: Incomplete Kawasaki Disease Clinically Diagnosed From Urgent Care: A Case-Report-Based Review

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When to Consider Rocky Mountain Spotted Fever in the Differential