Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:20

1308 Riboflavin Deficiency Rocky Mountain Spotted Fever

Signs & Symptoms

■pallor, angular stomatitis, cheilosis, red tongue, shark skin, photo-

phobia

tests

Laboratory

■Basic urine studies:

➣<30 mcg riboflavin/gram creatinine excretion

differential diagnosis

n/a

management

n/a

specific therapy

■Riboflavin 10–30 mg/day PO; treat associated vitamin deficiencies

Side Effects & Contraindications

■None

follow-up

n/a

complications and prognosis

■Reversible with replacement

ROCKY MOUNTAIN SPOTTED FEVER

RICHARD A. JACOBS, MD, PhD

history & physical

History

■Tick bite 3–12 days before onset of symptoms.

■Outdoor activity during spring or summer

■Disease reported in 48 states.

■Contact with dogs or rabbits

■Travel in highly endemic areas (N. Carolina, Missouri, Oklahoma,

Georgia, Montana, S. Dakota)

Signs & Symptoms

■Fever >40◦C and chills (100%), nausea and vomiting (50%), abdomi-

nal pain (50%), diarrhea (50%), cough (25%), confusion and stu-

por (25%)