Abstract
Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii characterized by fever, maculo-papular rash and a black eschar at the site of the tick bite (tache noire). Acute pancreatitis is a rare complication of MSF. We report a 45 year old man admitted with fever, maculopapular rash, and eschar (tache noire). The working diagnosis at admission was MSF. Five day after admission, the patient developed signs of an acute abdomen, amylase and lipase elevation, and ultrasound hypoechoic pancreas. CT scan revealed a stage B pancreatitis. An immunofluorescence antibody test confirmed Rickettsia conorii infection. Diagnosis of MSF was made and treatment with oral doxycycline was started. After five days of therapy, there was completed remission of epigastric pain and fever. Gastrointestinal and hepatic complications are described in association with MSF. Much rarer is pancreatic involvement. Inflammation may play a role in the pathogenesis of pancreatitis. This suggests that pancreas should be explored in MSF patients even in the absence of underlying risk factors.
Highlights
Mediterranean spotted fever (MSF) is a rickettsial disease caused by Rickettsia conorii endemic for countries along the Mediterranean coast (South Europe and North Africa) [1,2,3]
We described the case of a 45 year old man affected by MSF who developed acute pancreatitis
MSF is characterized by a generalized vasculitis process with the classic clinical triad of fever, rash and skin eschar at the site of the tick bite [6]
Summary
Mediterranean spotted fever (MSF) is a rickettsial disease caused by Rickettsia conorii endemic for countries along the Mediterranean coast (South Europe and North Africa) [1,2,3]. MSF is typically characterized by fever, maculopapular rash and a black eschar at the site of the tick bite (‘tache noire’). Severe forms of the disease with major morbidity and higher mortality risk have been described. Pancreatitis has been reported rarely [5].
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