American Board of Internal Medicine (ABIM) Certification Practice Exam

What condition is suggested by the symptoms of fever, petechial rash, and lymphocytic meningitis?

1. Lyme disease

2. Rocky Mountain spotted fever

3. West Nile virus infection

4. Viral meningitis

The correct answer is: Rocky Mountain spotted fever

The combination of fever, petechial rash, and lymphocytic meningitis points towards an infectious process that can lead to significant neurological and hematological manifestations. In this scenario, the symptoms closely align with Rocky Mountain spotted fever (RMSF), which is caused by the bacterium Rickettsia rickettsii. RMSF is characterized by a triad of fever, rash, and a history of exposure to ticks, particularly in endemic areas. The petechial rash that develops during RMSF is due to vasculitis affecting small blood vessels, leading to bleeding under the skin. Additionally, this infection can result in neurological symptoms, including meningitis and encephalitis, as it can affect the central nervous system. While other options might present with similar symptoms, the unique combination of fever, the distinct petechial rash, and the potential for lymphocytic meningitis fits clearly with RMSF. Viral meningitis, for instance, typically would not present with a petechial rash or the same acute illness severity associated with RMSF. Similarly, Lyme disease and West Nile virus infection present different symptom profiles that do not centrally include the petechial rash and acute lymphocytic meningitis seen in this scenario.