Malignant Mediterranean spotted fever

Mediterranean spotted fever has long been considered as a benign disease, but associated with septic shock and encephalitis, becomes malignant and potentially fatal. We present the case of a 77 year-old man admitted into the emergency room after tick bite in abdominal region and fever 39.6°C. After admission, a maculopapular rash appears with the achievement of palms and soles associated with behavioral changes and adult respiratory distress syndrome. In intensive care CSF examination revealed 6 nuclear elements and a protein level of 94 mg/dL, and electroencephalogram supported the existence of encephalitis. Rickettsia serology by indirect immunofluorescence showed IgG> 1/640 and IgM=1/80. Septic shock, responded to antibiotic therapy and patient was discharged to long term care. This case demonstrates that a benign and common disease suffered a poor outcome owing to the accelerated clinical course with acute onset and rapid deterioration.