Washington (AFP) - A tattooed, hoodie-wearing frontrunner suffering an 11th-hour stroke and a far-right firebrand surging into contention: the US state of Pennsylvania votes Tuesday in a midterm primary marked by more than its share of last-minute drama.
With key races across multiple states it is the most consequential day yet of a scorched-earth primary season -- and will provide the latest test of Donald Trump's continuing sway over his Republican Party.
Hopefuls in North Carolina, Oregon, Kentucky and Idaho are vying to be their party's representative in November's congressional and state ballots, but all eyes are on the Senate contest in the swing state of Pennsylvania.
For months the Republican race looked like a toss-up between hedge fund tycoon David McCormick and TV surgeon Mehmet Oz, who has former president Trump's endorsement -- like a string of successful candidates in the contests to date.
But the Pennsylvania race has been rocked in the final days by a come-from-behind surge from an insurgent contender, Kathy Barnette, who has drawn practically level with her big-spending rivals.
Barnette had been so far behind that the early frontrunners spent little time digging into her background until recent days, when a series of anti-Islam and homophobic statements were uncovered.
Oz, who would be the first Muslim Republican senator if elected, zeroed in on a 2015 social media post in which Barnette said that "pedophilia is a cornerstone of Islam."
She has denied posting the slur and told Fox News on Sunday that some of her inflammatory posts were aimed at starting a conversation, rather than "full thoughts."
She is also facing questions over her appearance at the "Stop the Steal" rally that turned into the 2021 US Capitol riot, and spreading Trump's false claims of election fraud.
'Full recovery'
A Fox News poll released this week showed Barnette with support from 19 percent of respondents, McCormick with 20 percent and Oz with 22 percent.
The anti-abortion Barnette has seen her popularity swell among conservatives after speaking powerfully about her mother being raped at age 11 and giving birth to her at just 12.
"In the world the Left desires, I would never have been born," she tweeted earlier this month.
"Frankly, things have shifted so quickly in the past 10 days that it is difficult to predict a winner," Donna Patterson, head of political science at Delaware State University, told AFP.
Whichever Republican triumphs on Tuesday will go head-to-head against the candidate for the Democrats -- who hope to wrest control of the Pennsylvania seat, and thereby cement their razor-thin control of the Senate.
Republican leaders worry Barnette will prove unable to expand her appeal beyond the party's base, costing it an eminently winnable race.
Trump echoed that message last week, warning Barnette would "never be able to win the general election against the radical left Democrats."
The ex-president's support for Oz will serve as a new test of his sway over Republicans, after a clean sweep of successful endorsements in the first three state primaries but failure of a high-profile candidate in Nebraska a week ago.
The Pennsylvania primary took another turn, this time on the Democratic side, as Lieutenant Governor John Fetterman, the overwhelming favorite for the party's Senate primary, suffered a stroke on Friday.
The tattooed, six-foot-nine-inch (2.05-meter) liberal said he had suffered no cognitive damage and was expected to make a "full recovery" but he remains hospitalized.
His campaign said Tuesday that he would have a pacemaker with a defibrillator implanted in what should be a "short procedure that will help protect his heart and address the underlying cause of his stroke."
According to the most recent Franklin and Marshall University poll, Fetterman leads Marine veteran and moderate US congressman Conor Lamb by nearly 40 percentage points.
