“Almost diagnostic is the hemorrhagic rash. Pathologically this consists of minute hemorrhages into the skin. Usually of pinhead size, these may reach a diameter of several inches or in fulminating cases amount to a diffuse purpura. Like other hemorrhagic rashes, they do not disappear on pressure. They continue bright for 2 or 3 days when they fade leaving a rusty stain. Most commonly they occur about the shoulder and pelvic girdle; in more severe cases, over the trunk, conjunctivae, mucosa, extremities, even the face. They come out very quickly and within 1 to 2 hours a patient previously without skin lesions may show an astounding number of these spots. From these the ancient term ‘spotted fever’ arises.”
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Thomas J. Marrie, MD, Section Editor
Conflict of Interest: Neither author has any conflicts of interest associated with the work presented in this manuscript.
Authorship: Both authors had access to the data and played a role in writing this manuscript.