title: Ongoing Cerebral Vasculitis During Treatment of Rocky Mountain Spotted Fever.
abstract: BACKGROUND
  Rocky Mountain spotted fever is a tickborne infection that produces a systemic small-vessel vasculitis; its prognosis is excellent if appropriate treatment is initiated early. Because the advent of effective antirickettsial therapies predates the widespread use of brain magnetic resonance imaging, there are limited data on the effect of untreated Rocky Mountain spotted fever infection on neuroimaging studies.
  
  
  METHODS
  We describe a 7-year-old girl with delayed treatment of Rocky Mountain spotted fever who suffered severe neurological impairment. Serial brain magnetic resonance images revealed a progressive "starry sky appearance," which is proposed to result from the same small vessel vasculitis that causes the characteristic skin rash of this infection.
  
  
  CONCLUSIONS
  Neurological injury can continue to occur despite specific antirickettsial therapy in Rocky Mountain spotted fever. This child's clinical features raise questions about the optimal management of this infection, particularly the utility of immune modulating therapies in cases of delayed treatment and neurological involvement.
authors: Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: lsun20@jhmi.edu.
authors: Lisa R
authors: LR
authors: Sun
authors: Section of Pediatric Neuroradiology, Division of Pediatric Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Thierry A G M
authors: TA
authors: Huisman
authors: Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Anusha K
authors: AK
authors: Yeshokumar
authors: Division of Pediatric Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Kennedy Krieger Institute, Baltimore, Maryland.
authors: Michael V
authors: MV
authors: Johnston
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D012373:Rocky Mountain Spotted Fever / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D013256:Steroids / Q000627:therapeutic use; D061665:Time-to-Treatment; D016896:Treatment Outcome; D020293:Vasculitis, Central Nervous System / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*
chemical_list: D007155:Immunologic Factors; D013256:Steroids
keywords: IVIG; Rocky Mountain spotted fever; rickettsia; starry sky; steroids; vasculitis