[Acute myocarditis complicating Mediterranean spotted fever. A case report]

Area of Science:

• Infectious Diseases
• Cardiology
• Genetics

Background:

• Mediterranean spotted fever (MSF), caused by Rickettsia conorii, is a significant tick-borne illness in North Africa.
• While typically benign, MSF can present with severe forms, particularly in individuals with Glucose-6-phosphate dehydrogenase (G6PD) deficiency.
• Myocarditis is a rare but serious complication of MSF, with limited documented cases.

Observation:

• A 15-year-old patient with G6PD deficiency presented with symptoms consistent with MSF, including fever and rash.
• The patient developed chest pain, ECG abnormalities (ST elevation), elevated troponin, and echocardiographic evidence of left ventricular dysfunction (ejection fraction 40%).
• Rickettsia conorii infection was confirmed serologically.

Findings:

• The case highlights myocarditis as a severe complication of MSF in a patient with G6PD deficiency.
• Successful treatment involved antibiotics (doxycycline and rifampicin) and standard myocarditis management (ACE inhibitors, beta-blockers, diuretics).
• The patient experienced a favorable outcome with complete recovery of left ventricular function.

Implications:

• This case underscores the importance of considering myocarditis in MSF patients, especially those with underlying conditions like G6PD deficiency.
• Prompt diagnosis and integrated treatment of MSF and its cardiac complications can lead to full recovery.
• Further research into the mechanisms and management of severe MSF complications is warranted.