title: Rickettsia africae infection complicated with painful sacral syndrome in an Italian traveller returning from Zimbabwe.
abstract: We report a case of Rickettsia africae infection complicated with painful sacral syndrome in an Italian traveller returning from Zimbabwe. The patient presented with fever, a tache noire on the left leg, and a neurological syndrome characterized by severe pain of the left leg, predominantly located in the left dorsal thigh and radiating to the calf; she had urinary retention and faecal incontinence. The diagnosis of R. africae was confirmed by polymerase chain reaction on a skin biopsy. The severe left leg pain persisted despite a complete course of doxycycline. A 4-month course of corticosteroids and the addition of carbamazepine was needed to achieve the control of pain. This case highlights the possibility of severe manifestations of R. africae infection and the possibility of a complex pathogenesis of the neurological syndrome, due perhaps to both the direct damage induced by R. africae and an immune-mediated mechanism.
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zammarchi
authors.affiliation: SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Farese
authors.affiliation: SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Trotta
authors.affiliation: SODc Neurofisiopatologia, DAI Neuroscienze, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Amantini
authors.affiliation: Unité des Rickettsies, Faculté de Médecine, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Raoult
authors.affiliation: Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Università Degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy; SOD Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy. Electronic address: alessandro.bartoloni@unifi.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bartoloni
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007558:Italy; D007866:Leg; D010146:Pain / Q000382:microbiology*; D012281:Rickettsia / Q000302:isolation & purification; D012282:Rickettsia Infections / Q000150:complications / Q000175:diagnosis*; D012445:Sacrococcygeal Region; D013577:Syndrome; D014195:Travel; D015030:Zimbabwe
keywords: Neurological complication; Pain; Painful sacral syndrome; Rickettsia africae; Travel