In contrast, antibiotic use usually results in defervescence in less than 7 days. Faintly erythematous maculopapules or rose spots occur on the trunk and may become hemorrhagic. Cervical adenopathy and hepatosplenomegaly are often present. Intestinal bleeding may occur from ulceration of mucosa overlying hyperplastic ileal Peyer patches. Altered mental status and seizures may occur.
Ocular manifestations are rare and occur in association with systemic illness.
These manifestations may include lid abscesses, corneal ulcers, uveitis, vitreous hemorrhage, retinal hemorrhage or detachment, optic neuritis, extraocular muscle palsies, orbital thromboses, and orbital abscesses. Most of the ocular complications probably result from direct invasion by the organism into ocular tissues. Involvement of a specialist in infectious disease is strongly encouraged. In addition, noninfectious cases of febrile illness, such as lymphoma, also should be considered. The duodenal string test may be used to culture bile.