[An unsuspected imported disease: meningo-encephalitis contracted in Spain]

A 13-year-old boy consulted a doctor during a holiday in Spain because of high fever, headache and exanthema. A local physician prescribed josamycin, but the medication was lost due to vomiting. A few days later, shortly after returning to the Netherlands, he was hospitalised with a life-threatening neurologic and multi-organ failure. It took two weeks before the diagnosis 'Mediterranean spotted fever' was made and an appropriate antibiotic treatment was started. The patient made a slow but successful recovery. Rereading the hand-written Spanish medical report revealed that it had mentioned a correct diagnosis and adequate treatment. An apparently safe holiday destination thus does not exclude an imported disease. Knowledge of local epidemiology and good communication with the locally consulted medical system are essential for a correct diagnosis and therefore for appropriate treatment and a good prognosis.