This is a 16-year-old adolescent from the urban area of the municipality of Útica (Cundinamarca), a high school student of mixed race, who consulted for a consistent sensation of dry fever last two days of evolution.
The system review was negative.
The patient was treated with acetaminophen and amoxicillin without improvement.
The clinical history was not relevant.
The patient reported the presence of horses, cats and dogs in the drinking area located in the peridomicile.
Located by arthropods or travel to other regions in the last month.
Upon admission, the patient was in acceptable general conditions, hydrated, with a temperature of 37 °C, moist congestive mucosa and mobile neck without lymphadenopathy.
There was no skin rash or neurological deficit.
The rest of the physical examination was normal.
He was kept under observation with a diagnosis of acute viral laryngitis and started treatment with acetaminophen and intravenous fluids.
In the initial laboratory tests, it was found: 4.5 leukocytes per 10 9 /L (neutrophils, 65.2 %; lymphocytes, 30.2 %); platelets, 173,000/mm 3, hematocrit 51, 16.8 g.
After 12 hours of admission, leukopenia (2.8 leukocytes per 10 9 /L; neutrophils, 48.3%; lymphocytes, 44.3 %) and thrombocytopenia (platelets, 145.000) were found in the helmet.
At this time, the patient remained in acceptable general conditions, with no changes in physical examination, hydrated and afflicted.
Due to the clinical picture at admission, the area of origin and leukopenia associated with thrombocytopenia, as evidenced in the control condition, a clinical suspicion of dengue fever without warning signs was determined.
She was hospitalized and continued to be managed with intravenous fluids, antipyretics, and conservative management every 12 hours.
Among the differential diagnoses, ritesias infection was considered, given its role as a cause of acute febrile syndrome in the geographical area.
On the fifth day of hospitalization, a blood sample was taken with the consent of the patient for separation of dengue and diagnostic analysis of dengue (IgM ELISA capture-Panbio dilution®) and Don parko rinchia serum, IgG, was identified as the major strains of R.
The patient was hospitalized for six days until resolution of both leukopenia and thrombocytopenia was observed.
During the same period, the patient presented acceptable general condition except for the presence of nausea without vomiting in the last two days of hospitalization, which required metoclopramide.
No new febrile peaks, changes in physical examination or hemorrhagic manifestations were documented.
It was then decided to discharge the patient, with follow-up appointment by external consultation after 15 days.
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During the follow-up appointment (15 days later) a new serum sample was taken to confirm the diagnosis as a stage of convalescence of congenital malformations.
The following results were observed: IgM for dengue negative and significant elevation of titers against R. felis (difference of four or more titers between the acute phase and the convalescence sample).
The results suggested the diagnosis of flea-borne spotted fever.
