Mediterranean Spotted Fever with an Acute Pancreatitis

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.

Hemorrhagic-Necrotizing Pancreatitis – An Unusual Complication of Mediterranean Spotted Fever

“…According to some reports, however, rickettsial vascular injury of the pancreas occurs frequently, although the parenchymal lesions might not be severe enough to qualify as pancreatitis [8]. In some of the cases reported in the literature, the pancreatic involvement was mild, with a prompt response to antibiotic therapy [9,10]. Another report, however, announced a serious multiorgan involvement, including the pancreas in patients with South African tick bite fever, and rickettsiae were demonstrated in vascular endothelium of pancreatic septa [11].…”