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Abstract
A report is made of a 25-year-old patient, admitted to the University of Iowa Hospital with an acute febrile illness, which rapidly worsened in the presence of unimpressive routine laboratory tests. Initially the leucocyte count was 5 800 with a marked shift to the left, and a qualitative nitroblue tetrazolium test (NBT) was markedly elevated (66%). Because of the appearance of a erythematous rash in the patient, a therapeutic trial with tetracyclines was carried out. A prompt improvement of his clinical condition was parallelled by normalization of the NBT tests. Several days later, a complement fixation test for Rocky Mountain spotted fever (RMSF) was diagnostic. This is the first case of RMSF with abnormality in the NBT test demonstrated.