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A 67-year-old resident of Hyannis presented to a local hospital with a seven-day history of fever, fatigue, confusion, headache, and a dry cough. He recalled having been exposed to ticks. He was febrile (temperature, up to 39.8 °C) and had hypotension and tachypnea. The physical examination was unremarkable. Laboratory values included a white-cell count of 6000 per cubic millimeter, a platelet count of 46,000 per
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