Rocky Mountain Spotted Fever

Prior to the introduction of broadspectrum antibiotics, Rocky Mountain spotted fever was a devastating disease. Subsequently, the mortality has dropped from 20%1-3to approximately 5%,2,4and the illness is frequently considered to be benign if appropriately treated. The fact that the generalized vasculitis of Rocky Mountain spotted fever can be life-threatening in spite of prompt therapy with chloramphenicol or one of the tetracyclines is not always recognized. The following cases illustrate the complications of this vascular damage and emphasize the importance of appropriate management and therapy based upon an understanding of the pathophysiologic derangements. Patient Summaries Patient 1. —A 35-year-old white man was hospitalized in June 1967 with a four-day illness characterized by chills, photophobia, headache, lassitude, nausea, vomiting, and diarrhea. A history of tick bites during a recent vacation on an Oklahoma farm was elicited. On admission he had a temperature of 105 F (40.6 C) and