title: [Late diagnosis of fatal invasive rickettsial disease in the Intensive Care Unit].
abstract: Mediterranean spotted fever is an infectious disease belonging to the rickettsial group due to an intracellular bacterium: Rickettsia Conorii. Pauci-symptomatic and benign forms are predominant. Severe forms are rare and increasingly reported in the recent literature with potentially life-threatening severe multi-systemic involvement. We here report a very rare case of a 52-year old patient admitted to an Intensive Care Unit with convulsions, septic shock and acute renal failure. On the second day, given the discovery of « inoculation chancre »-like lesions which needed to be treated, the diagnosis of severe rickettsial disease with severe multivisceral involvement was suspected and then confirmed by serology. Antibiotic treatment with doxycycline was then administered. However the patient developed acute tubular necrosis requiring extrarenal purification sessions. The patient rapidly developed fatal multivisceral failure. Rickettsiosis is associated with microcirculatory vasculitis thus leading to severe clinical manifestations. The mechanisms involved and the possible prognostic factors have been discussed in this study through a review of the literature.
authors.affiliation: Réanimation Médicale à la Faculté de Médecine de Tunis, Hôpital de Zaghouan, Avenue de l'Environnement, 1100 Zaghouan, Tunisie.
authors.forename: Hassen Ben
authors.initials: HB
authors.lastname: Ghezala
authors.affiliation: Chirurgie Générale à la Faculté de Médecine de Tunis, Hôpital de Zaghouan, Avenue de l'Environnement, 1100 Zaghouan, Tunisie.
authors.forename: Najla
authors.initials: N
authors.lastname: Feriani
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001907:Boutonneuse Fever / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D057210:Delayed Diagnosis; D004318:Doxycycline / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D020114:Rickettsia conorii / Q000302:isolation & purification*; D012640:Seizures / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology*
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline
keywords: Intensive Care Unit; Rickettsia Conorii; Rickettsiosis; mortality