An eight-year-old girl presents with vomiting, headaches, and partial paralysis after a tick exposure during a mountain hike. What condition could be affecting this patient?

• A. Rocky Mountain Spotted Fever
• B. Lyme Disease
• C. Anaplasmosis
• D. Ehrlichiosis

Answer: (A)

This scenario points to a tick-borne illness that can cause fever, severe headache, vomiting, and neurological signs in a child. Rocky Mountain Spotted Fever is caused by Rickettsia rickettsii and is transmitted by Dermacentor ticks. It often presents with abrupt fever and headache, with vomiting common in children; as the illness progresses, inflammation of blood vessels (vasculitis) can involve the brain and spinal cord, leading to confusion, seizures, or weakness such as partial paralysis. The skin rash may appear a few days after fever begins, but its absence early does not rule it out.

Lyme disease usually starts with an expanding erythema migrans rash and later joint or neurologic symptoms, not the immediate combination described. Anaplasmosis and ehrlichiosis can cause fever and headache and sometimes GI symptoms, but CNS involvement with focal deficits like partial paralysis is less typical early on. Therefore, the presentation most consistent with these findings is Rocky Mountain Spotted Fever.