A 16-yo boy returned from the mountains of southern Spain with several days of fever, severe headache, myalgias, nausea, vomiting, and conjunctival hemorrhages. Labs showed thrombocytopenia and this peripheral blood Giemsa stain. What is it?
Babesiosis
Rocky Mountain spotted fever
Tick-borne relapsing fever
Dengue hemorrhagic fever
Syphilis
You are correct. Tick-borne relapsing fever from Borrelia spirochetes (see blood smear) typically occurs in mountainous areas like the Western US, often linked to sleeping in rustic, rodent-infested cabins. His symptoms gradually resolved after doxycycline x 5 days.