A patient with spotted fever group rickettsiosis mimicking connective tissue disease.

Common clinical features associated with spotted fever group (SFG) rickettsioses include fever, headache, arthralgia, arthritis, gastro-intestinal disturbances, lymphadenopathy, hepato-splenomegaly and a discrete maculo-papular rash [1]. However, diverse clinical manifestations associated with SFG rickettsioses have been reported, some presenting with a continued febrile illness with no definite features suggestive of rickettsioses [2]. We describe a patient with SFG rickettsiosis who had small joint arthropathy, cervical lymphadenopathy, hair loss, oral ulceration, and intermittent high fever over a 4 month period. She was later confirmed of having SFG rickettsioses and all her clinical features resolved with anti-rickettsial antibiotics.