RESUMENLa fi ebre botonosa mediterránea es una enfermedad infecciosa aguda incluida en el grupo de las rickettsiosis humanas, causada por Rickettsia conorii, con distribución geográfi ca circunscrita a los países mediterráneos donde es considerada como endémica. En España se ha observado en las últimas dos décadas un aumento de la incidencia y la presencia de casos en regiones geográfi cas distintas a la zona endémica descrita por el propio nombre de la enfermedad, que se ha correlacionado con las altas temperaturas y el bajo nivel de precipitaciones. Es una enfermedad generalmente benigna, de gravedad moderada y con baja mortalidad, cuyo espectro clínico varía desde casos asintomáticos hasta una excepcional forma «maligna» caracterizada por una afección visceral importante, especialmente insufi ciencia renal, coagulación intravascular diseminada con exantema purpúrico, alteración hepática grave, infi ltrados pulmonares y alteración de la conciencia. Describimos el caso de un paciente con fi ebre botonosa mediterránea maligna que evolucionó de forma favorable. Palabras clave: Fiebre botonosa mediterránea, rickettsiosis, fi ebre botonosa mediterránea maligna. SUMMARY Mediterranean fever is an acute infectious disease included in the group of human rickettsiosis, caused by Rickettsia conorii, with geographic distribution circumscribed to the Mediterranean countries where it is considered endemic.In Spain, in the last two decades, there has been an increase in the incidence and presence of cases in geographical regions other than the endemic area described by the name of the disease, which has been correlated with the high temperatures and the low level of precipitations. It is a generally benign with low mortality associated. Its clinical spectrum varies from asymptomatic cases to an exceptional «malignant» form characterized by an important visceral compromise, especially renal failure, disseminated intravascular coagulation with purpuric rash, severe hepatic alteration, pulmonary infi ltrates and altered level of consciousness. We describe the case of a patient with Malignant Mediterranean fever that evolved favorably.
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