Rocky Mountain spotted fever exam finding in early RMSF?

• A. Erythematous circular rash with central clearing
• B. Facial flushing and conjunctivitis
• C. Maculopapular rash on the trunk that spreads to the extremities
• D. Tic douloureux

Answer: (B)

Early Rocky Mountain spotted fever is marked by fever and notable ocular involvement from the outset—conjunctival injection due to small-vessel vasculitis caused by Rickettsia rickettsii. This eye finding helps distinguish RMSF in the initial phase, even before the rash appears. The rash in RMSF typically develops later and usually starts on the wrists and ankles before spreading to the trunk, so a trunk-predominant rash or a ring-shaped lesion points away from the early presentation. The other option described facial flushing with conjunctivitis, and while facial flushing can accompany fever, the conjunctival injection is the key early clue for RMSF. Tic douloureux is unrelated to RMSF.