Myocarditis in Mediterranean spotted fever: a case report and a review of the literature

Abstract

Introduction:Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii. Most cases follow a benign course, with a case fatality rate of 3–7 % among hospitalized patients. Complications are described mainly in adult patients and include hepatic, renal, neurological and cardiac impairment. Among cardiac complications, pericarditis, myocarditis and heart rhythm disorders are uncommon complications in MSF and only a few cases have been reported in the literature.Case Presentation: We describe a new case of acute myocarditis complicating MSF in an immunocompetent adult patient without risk factors for severe MSF.Conclusion:Myocarditis is an uncommon but severe complication of MSF. Clinicians should be aware of a possible cardiac involvement in patients with MSF. Close monitoring and an aggressive approach are essential to reduce mortality rates of MSF.

Rickettsiales in Italy

“…The typical signs of these rickettsioses, with the formation of papules, petechiae and rash, are a direct consequence of the colonization and damage of the vascular endothelium by these pathogens. MSF may be complicated by cardiac symptoms (coronary artery ectasia, myocarditis and atrial fibrillation), ocular symptoms (uveitis, retinal vasculitis and retinopathy), neurological symptoms (cerebral infarction, meningoencephalitis have been reported and, sensorineural hearing loss), pancreatic involvement, splenic rupture and acute renal failure, and by hemophagocytic syndrome [ 146 , 148 , 149 , 150 , 151 , 152 , 153 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 ]…”

An Atypical Case of Rickettsial Spotted Fever Myocarditis Mimicking Weil’s Disease

“…Rickettsia helvetica is known to cause noneruptive infections like in our case [6]. Few cases of myocarditis, pericarditis, atrial fibrillation, and ectasia of coronary arteries have been reported due to R. conorii infections worldwide [16, 17]. According to Colomba et al [16], there had been only one case report of myocarditis due to SFG rickettsia infection from Asia up to 2016.…”

“…Few cases of myocarditis, pericarditis, atrial fibrillation, and ectasia of coronary arteries have been reported due to R. conorii infections worldwide [16, 17]. According to Colomba et al [16], there had been only one case report of myocarditis due to SFG rickettsia infection from Asia up to 2016. Nevertheless, we found a past report in a local journal on myocarditis due to rickettsioses from the Western Province of Sri Lanka, but the infecting organism (whether Orientia tsutsugamushi or SFG rickettsia) had not been clearly mentioned there [18].…”

A severe case of Mediterranean spotted fever: value of ocular examination

“…In fact, atypical forms can be observed with multiorgan involvement including hepatic, renal, neurological and cardiac impairment. [1][2][3][4] We here in report a difficult diagnosis of rickettsiosis occuring after hemorrhagic fever. We also describe EN-FACE-OCT rickettsiosis retinal findings and emphasize the importance of ocular examination in atypical forms of rickettsiosis.…”