tick

A 70-year-old male with presents with 5 days of fever and 3 days of anuria and malaise.  He also notes worsening abdominal distention and shortness of breath. He found and removed a tick 3 weeks ago and another one 1 week ago. Labs reveal WBC 2,200 cells/microL, HGB 11.2 g/dL, Plt 21 × 109/L, BUN 86 mg/dL, Creatinine 6.8 mg/dL, AST 350 U/L, ALT 119 U/L.

Great review from REBEL EM on RMSF

A 35-year-old male presents for intermittent fevers, abdominal pain, and headaches for 3 weeks. On further questioning, he also states he has arthralgias. Review of systems is remarkable for a recent camping trip in the Boundary Waters Canoe Area of Minnesota. You find a bulls-eye rash on his trunk. What are your next steps?