{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:10:02Z","timestamp":1756318202539,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,2,5]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:p>A young healthy gardener became febrile with abdominal pain, nausea, vomiting and diarrhoea followed by palpable purpura, mostly on the legs and buttocks with associated arthralgia. Dehydration, azotemia and hyponatraemia resolved with fluid replacement. Tests demonstrated acute pancreatitis, hepatitis, thrombocytopenia, microscopic haematuria and proteinuria. He improved with doxycycline, but bipedal pitting oedema and punctate rash involving the soles\/hands appeared. Microbiological tests revealed positive IgM and IgG serology for rickettsiae spotted fever. Skin biopsy of the purpura confirmed leucocytoclastic vasculitis, positive for <jats:italic>Rickettsiae conorii<\/jats:italic> by PCR amplification. Palpable purpura is a rare important manifestation of Mediterranean spotted fever (MSF), due to either secondary leucocytoclastic vasculitis or associated Henoch-Schonlein purpura (HSP), which best explains the distribution of the rash, arthralgia, gastrointestinal symptoms, and microhaematuria not usually seen in <jats:italic>R. conorii<\/jats:italic> infections. Likewise, the patient\u2019s acute pancreatitis may be interpreted as a rare presentation of HSP or a seldom-encountered feature of MSF.<\/jats:p>","DOI":"10.1136\/bcr-2020-238440","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T11:01:20Z","timestamp":1614078080000},"page":"e238440","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Mediterranean spotted fever associated with leucocytoclastic vasculitis and acute pancraeatitis"],"prefix":"10.1136","volume":"14","author":[{"given":"Ami","family":"Schattner","sequence":"first","affiliation":[{"name":"The Faculty of Medicine, Hebrew University Hadassah, Jerusalem, Israel"},{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ina","family":"Dubin","sequence":"additional","affiliation":[{"name":"Laniado Hospital, Sanz Medical Centre, Netanya, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"2025082710372442000_14.2.e238440.1","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.idc.2018.10.010","article-title":"The rickettsioses: a practical update","volume":"33","author":"Blanton","year":"2019","journal-title":"Infect Dis Clin North Am"},{"key":"2025082710372442000_14.2.e238440.2","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0891-5520(20)30617-6","article-title":"Dermatologic manifestations of arthropod-borne diseases","volume":"8","author":"Myers","year":"1994","journal-title":"Infect Dis Clin North Am"},{"key":"2025082710372442000_14.2.e238440.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1346-8138.2006.00021.x"},{"key":"2025082710372442000_14.2.e238440.4","first-page":"1238","article-title":"Surveillance for spotted fever group rickettsial infections: problems, pitfalls, and potential solutions","volume":"221","author":"McClain","year":"2020","journal-title":"J Infect Dis"},{"key":"2025082710372442000_14.2.e238440.5","doi-asserted-by":"crossref","first-page":"153","DOI":"10.14740\/gr858w","article-title":"Review of infectious etiology of acute pancreatitis","volume":"10","author":"Rawla","year":"2017","journal-title":"Gastroenterology Res"},{"key":"2025082710372442000_14.2.e238440.6","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/s00296-012-2652-5","article-title":"Two brucellosis cases with vasculitic skin lesions","volume":"34","author":"Albayrak","year":"2014","journal-title":"Rheumatol Int"},{"key":"2025082710372442000_14.2.e238440.7","first-page":"91","article-title":"Mediterranean spotted fever presenting as an acute pancreatitis","volume":"74","author":"Rombola","year":"2011","journal-title":"Acta Gastroenterol Belg"},{"key":"2025082710372442000_14.2.e238440.8","unstructured":"Arnold DM , Cuker A . 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