title: Myocarditis in Mediterranean spotted fever: a case report and a review of the literature.
abstract: BACKGROUND
  Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused byRickettsia conorii. Most cases follow a benign course, with a case fatality rate of 3-7 % among hospitalized patients. Complications are described mainly in adult patients and include hepatic, renal, neurological and cardiac impairment. Among cardiac complications, pericarditis, myocarditis and heart rhythm disorders are uncommon complications in MSF and only a few cases have been reported in the literature.
  
  
  METHODS
  We describe a new case of acute myocarditis complicating MSF in an immunocompetent adult patient without risk factors for severe MSF.
  
  
  CONCLUSIONS
  Myocarditis is an uncommon but severe complication of MSF. Clinicians should be aware of a possible cardiac involvement in patients with MSF. Close monitoring and an aggressive approach are essential to reduce mortality rates of MSF.
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Colomba
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Siracusa
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Trizzino
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Gioè
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Giammanco
authors.affiliation: Dipartimento di Scienze per la promozione della salute e materno-infantile, Università di Palermo , Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Cascio
keywords: Mediterranean; conorii; fever; myocarditis; rickettsia; spotted