title: First report of mild Brazilian spotted fever associated to arthritis.
abstract: We describe the first Brazilian case of mild Rickettsiosis, complicated by knee monoarthritis, in young adult bitten by a tick on his left leg in Camburi zone, located in São Sebastião municipality, southern coastal region of the State of São Paulo, in the Atlantic rainforest region, Brazil. The patient developed inoculation eschar at the tick bite site associated with enlarged lymph nodes in the left groin, fever, polyarthralgia, headache and macular rash. Twenty days after tick bite episode, he displayed monoarthritis in his right knee. The diagnosis of mild Rickettsiosis was established by sequential immunological analysis in serum and synovial fluid, using the indirect immunofluorescence (IF) assay for antibodies reactive with Rickettsia parkeri and Rickettsia rickettsii. The mild Rickettsiosis is an emerging zoonosis, that must be investigated by physicians, including rheumatologists, in patients that present macular rash, fever and eventually arthritis, after visiting the southern coastal Atlantic rainforest region in Brazil.
authors: Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Virgínia Lucia Nazario
authors: VL
authors: Bonoldi
authors: Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Roberta Gonçalves
authors: RG
authors: Marangoni
authors: Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Giancarla
authors: G
authors: Gauditano
authors: Faculdade de Medicina Veterinária, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Jonas
authors: J
authors: Moraes-Filho
authors: Faculdade de Medicina Veterinária, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Marcelo Bahia
authors: MB
authors: Labruna
authors: Departamento de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
authors: Natalino Hajime
authors: NH
authors: Yoshinari
mesh_terms: D000328:Adult; D001168:Arthritis / Q000382:microbiology*; D001938:Brazil; D006801:Humans; D008297:Male; D012282:Rickettsia Infections; D012720:Severity of Illness Index