Did your patient have Tularemia or Rocky Mountain Spotted FEver?
Tularemia. Only case I have ever seen. In Arkansas. In practice for 20 years. Have seen quite a few cases of RMSF. Diagnosed with febrile agglutin tests. His were very high according to the infectious dz. doctor. She said his type of illness only occurred in about 15% of cases. It did take about 5 days to make the diagnosis bacause he presented with acute cholecystitis. But he kept running fever so after thinking what else could it be I ran the tests. I am glad I did. I wasn't expecting Tularemia. I was think maybe RMSF and the GB was just a conincidence.