An 18-month-old girl who consulted for a tick bite on her head detected 24 hours before.
The mother believes that it could happen 3-4 days before, because they made an exit to the country (April months).
Domestic animals (dogs or other pets) did not live with them.
The tick was removed manually and was about 5 mm in diameter.
On the day of the consultation, fever began and you noticed lumps in your head.
On examination, the patient was in good general condition, although irritable and somewhat declining.
In the left parietoccipital region, there was a rare anomaly of approximately 7 mm in diameter mild erythema.
The skull had multiple mastoid and cervical posterior diseases of small size between 1 and 1.5 cm in diameter, slightly painful to adenopation.
The rest of the examination was normal and there were no rashes.
Initially, an analytical test was requested to study tick bite and treatment with amoxicillin-clavulanic acid was recommended, thought about a possible overinfection of the sting.
Controlled afterwards, protein binding persisted, lymphadenopathy and fever persisted. Laboratory results showed leukocytosis with increased erythrocyte sedimentation rate (SV) up to 20 mm/h
The bad evolution of the clinical picture and due to suspicion of rickettsiosis, the case was consulted with the specialists in infectious diseases of our reference hospital and it was decided to treat with oral ciprofloxacin, requesting a new analytical with
The patient is followed up a week later, with persistent fever and good evolution of lymphadenopathies, which return slowly, only a small area of alopecia of about 2 cm in diameter persists.
The control laboratory showed a decrease in leukocytosis and SV.
The second serological test ten days later showed a titer of R. connori: IgG ≤ 1:40 and IgM 1:320.
No sample could be sent for R. slovaca study.
At two months the child was asymptomatic and serology showed lower titers against R. connori IgG 1:40 and IgM ≤ 1:40.
