Relative bradycardia (less tachycardia than expected for the degree of fever) may occur in up to 50% of patients but is not a reliable diagnostic indicator.
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.
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