A case of rocky mountain spotted fever without eschar as a cause of pyrexia with multiple organ failure

Rocky mountain spotted fever (RMSF) is a rickettsia disease frequently reported from North America and Europe and transmitted by tick bite. This disease is very rare in India and other parts of South East Asia. Fever with rash and thrombocytopenia are the hallmark clinical presentations of viral hemorrhagic fever but other diseases like malaria, typhoid, Leptospira and rickettsia diseases should also be considered in differential diagnosis. Knowledge of geographical distribution, evidence of exposure to the vector and a high degree of clinical suspicion of rickettsia diseases are very important for early differentiation from other diseases to prevent lethal complications and institute initial treatment. We report a rare case of rocky mountain spotted fever (RMSF) from New Delhi, which was confirmed by specific indirect immunofluorescence assay (IIF).