Child Neurology: Rocky Mountain spotted fever encephalitis

A 27-month-old previously healthy boy developed irritability and a fever the day after getting his 2-year vaccinations. Three days later, he developed a centripetally spreading petechial rash. A tick was removed from his neck. He was taken to an outside hospital several times over the course of 3–4 days and was discharged with amoxicillin the first time and ceftriaxone on a subsequent visit. Eight days into his illness, he developed depressed level of consciousness and had what was described as a generalized clonic seizure. He was intubated with paralytics and fentanyl and transferred to our hospital for evaluation and management. The remaining history was unremarkable.