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Drug eruption

Can mimic the rash but is more likely to be morbilliform and pruritic, and is identified by a temporal relationship with a new medication.

Ehrlichiosis

Another tick-borne illness that often presents with fever and headache but has a rash less frequently, and the rash is typically maculopapular, not petechial.

Kawasaki disease

Primarily affects young children and is distinguished by its constellation of features: conjunctivitis, oral mucosal changes ('strawberry tongue'), cervical lymphadenopathy, and extremity changes.

Secondary syphilis

The rash can be maculopapular but classically involves the palms and soles, and is associated with other signs like condyloma lata and a positive syphilis serology.

Viral exanthem

Usually presents with a prodrome and a maculopapular rash that starts on the trunk and spreads centrifugally, rather than the initial acral petechial rash of RMSF.

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