title: Indian tick typhus presenting as Purpura fulminans.
abstract: Seriously ill patients presenting with purpura fulminans, sepsis and multi-organ failure often require extensive diagnostic workup for proper diagnosis and management. Host of common infections prevalent in the tropics, e.g. malaria, dengue; other septicemic infections e.g. meningococcemia, typhoid, leptospirosis, toxic shock syndrome, scarlet fever, viral exanthems like measles, infectious mononucleosis, collagen vascular diseases (Kawasaki disease, other vasculitis) diseases, and adverse drug reactions are often kept in mind, and the index of suspicion for rickettsial illness is quite low. We present a case of Indian tick typhus presenting with purpura fulminans (retiform purpura all over the body), sepsis and multiorgan failure without lymphadenopathy and eschar, successfully treated with doxycycline and discharged home. Hence, a high index clinical suspicion and prompt administration of a simple therapy has led to successful recovery of the patient.
authors.affiliation: Department of Critical Care Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Suhasini
authors.initials: S
authors.lastname: Tirumala
authors.affiliation: Department of Microbiology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Bijayini
authors.initials: B
authors.lastname: Behera
authors.affiliation: Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Srikanth
authors.initials: S
authors.lastname: Jawalkar
authors.affiliation: Department of General Medicine, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Pradeep Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Department of Dermatology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Pavithra Vani
authors.initials: PV
authors.lastname: Patalay
authors.affiliation: Department of Pathology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Ayyagari
authors.affiliation: Department of Microbiology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India.
authors.forename: Pavani
authors.initials: P
authors.lastname: Nimmala
keywords: Indian tick typhus; Rickettsia; Weil–Felix test; doxycycline; purpura
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