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Tick Bite Appendicitis

Eli Schwartz, MD; David R. Shlim, MD
JAMA. 1988;259(24):3561. doi:10.1001/jama.1988.03720240023024.
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To the Editor.  —We would like to report a case that emphasizes basic physical examination technique.

Report of a Case.  —A 26-year-old male tourist arrived in Kathmandu, Nepal, then traveled to the jungle area south of Nepal for the next few days. He flew up to the village of Jomoson (3048 m), where he developed diarrhea, vomiting, and fever shortly after arrival. He was seen by a physician in the local hospital who detected lower right quadrant tenderness and suspected acute appendicitis.He was advised to fly back to Kathmandu as soon as possible, since surgical facilities were not available in Jomoson. On presentation to our clinic in Kathmandu he did not appear to be in acute distress, though he complained of lower right quadrant abdominal pain. He had a temperature of 37.8°C and a pulse rate of 60 beats per minute. Abdominal examination revealed point tenderness just lateral to


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