Severe Mediterranean Spotted Fever Presenting with Septic Shock and Multiple Organ Dysfunction Syndrome: A Case Report
TL;DR
The case of a 61-year-old man with poorly controlled type 2 diabetes mellitus who presented with a 15-day history of fever, generalized maculopapular rash, and progressive confusion highlights that Mediterranean spotted fever should be considered in the differential diagnosis of septic shock associated with fever, rash, and an inoculation eschar in endemic areas.
Abstract
Background: Mediterranean spotted fever , caused by Rickettsia conorii, is an endemic tick-borne zoonosis in the Mediterranean region. Although the disease is usually self-limiting, severe forms complicated by septic shock and multiple organ dysfunction syndrome are uncommon and potentially life-threatening. Early recognition and prompt initiation of doxycycline are crucial to improve outcomes. Case Presentation: We report the case of a 61-year-old man with poorly controlled type 2 diabetes mellitus (HbA1c 10%) who presented with a 15-day history of fever, generalized maculopapular rash, and progressive confusion. On admission, he was febrile (39°C) and in septic shock with hypotension, tachycardia, oliguria, and a Glasgow Coma Scale score of 13/15. Physical examination revealed a characteristic inoculation eschar in the right gluteal region. Laboratory investigations showed marked systemic inflammation, thrombocytopenia, acute kidney injury, hepatocellular injury with cholestasis, hyperlactatemia, and coagulation abnormalities. Serological testing by indirect immunofluorescence assay detected anti-Rickettsia conorii IgG antibodies. The diagnosis of severe Mediterranean spotted fever complicated by septic shock and multiple organ dysfunction syndrome (SOFA score: 10) was established. The patient received intravenous crystalloids, norepinephrine, doxycycline, ciprofloxacin, methylprednisolone, insulin therapy, gastric protection, and venous thromboembolism prophylaxis. His clinical course was favorable, with progressive resolution of organ dysfunction, successful discontinuation of vasopressor support, and transfer to the Infectious Diseases Department. Conclusion: This case highlights that Mediterranean spotted fever should be considered in the differential diagnosis of septic shock associated with fever, rash, and an inoculation eschar in endemic areas. Early diagnosis, prompt doxycycline therapy, and timely intensive care management are essential for improving patient outcomes