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Mechanism of upper gastrointestinal hemorrhage in Mediterranean spotted fever

R Ruiz-Beltrán1, J I Herrero-Herrero, D H Walker

  • 1Department of Medicine, University Hospital, Salamanca, Spain.

Tropical and Geographical Medicine
|January 1, 1990
PubMed

Insights

Gastrointestinal bleeding is a rare complication of Mediterranean spotted fever (MSF). This study details three MSF cases with upper GI bleeding, revealing vasculitis in the gastric mucosa as the cause.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Pathology

Background:

  • Mediterranean spotted fever (MSF) is a tick-borne illness typically presenting with fever, rash, and a lesion at the tick bite site.
  • Gastrointestinal hemorrhage is an uncommon complication of MSF, rarely reported in the literature.

Observation:

  • Three patients with MSF in Salamanca, Spain, presented with upper digestive tract bleeding.
  • These patients exhibited a purpuric rash and hypoalbuminemia, indicative of severe disease forms.
  • The bleeding complication occurred late in the disease course, 13-20 days after fever onset.

Findings:

  • Histologic examination revealed multiple acute superficial erosions of the gastric mucosa in two patients.
  • The underlying cause was identified as a lymphohistiocytic vasculitic process affecting small gastric vessels.
  • This rickettsial vascular injury in the gastric wall is histologically similar to that seen in other organs in MSF.

Implications:

  • Upper gastrointestinal bleeding can be a manifestation of severe Mediterranean spotted fever.
  • Understanding the vasculitic etiology is crucial for diagnosing and managing GI complications in MSF patients.
  • This highlights the importance of considering MSF in patients with unexplained GI bleeding, especially in endemic areas.

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