Mediterranean spotted fever in the emergency department

Introduction: Mediterranean spotted fever (MSF) is one of the tick-borne rickettsial infections caused by Rickettsia conorii. In this case, we describe a patient who was admitted to the Emergency Department (ED) with persistent fever caused by MSF. Case Report: A 36-year-old male patient was admitted to the ED with persistent fever. Six days ago, antibacterial therapy had been started by his family practitioner; however, his fever continued. Upon admission on the seventh day of fever, the patient appeared ill. He had complaints such as malaise, myalgias, and nausea/vomiting. His fever was 38.6 degrees C, and other vital signs were normal. On physical examination, a single, crusted, ulcerated papule with a red halo resembling a cigarette burn was observed on the left leg. According to the diagnostic criteria for MSF, his score was 33, and he was admitted to the infectious disease department. Antibodies against Rickettsia were positive with the immunofluorescence assay. Fever after continuing for 24 hours reduced when a dose of 200 mg/daily doxycycline treatment was started. Conclusion: The aim of this presentation is to point out that MSF should be considered in the ED for the differential diagnosis of patient with a history of tick bite, persistent fever, maculopapular rash, headache, myalgia, arthralgia, and particularly with black eschar/tache noire