{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:32:46Z","timestamp":1788021166561,"version":"build-2784847793"},"reference-count":22,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T00:00:00Z","timestamp":1671580800000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,11,26]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p>A previously well man in his 50s returned to the UK after a trip to the Mediterranean. The day after returning he developed malaise, fevers, rigors and severe headache. He was hospitalised with sepsis, multiorgan involvement, a maculopapular rash and an eschar on each hip. Serology was positive for <jats:italic>Rickettsia<\/jats:italic> spp (spotted fever group) with a rise in titre from 1:64 to 1:1024 eight\u2009days later. Blood and tissue PCR were also positive for <jats:italic>Rickettsia<\/jats:italic> spp. He had cardiac, pulmonary, renal, ocular and neurological involvement. He completed a 14-day course of doxycycline and recovered well. This is a case of likely Mediterranean spotted fever (MSF) caused by <jats:italic>Rickettsia conorii,<\/jats:italic> which is endemic to the Mediterranean basin. We highlight the need for awareness and early treatment to prevent severe complications. This case is also the first to describe Purtscher-like retinopathy in the context of likely MSF.<\/jats:p>","DOI":"10.1136\/bcr-2022-249426","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T10:47:48Z","timestamp":1671619668000},"page":"e249426","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Mediterranean spotted fever with multiorgan involvement"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7169-7816","authenticated-orcid":false,"given":"Kimberly","family":"Davis","sequence":"first","affiliation":[{"name":"Microbiology\/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Headington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0860-3629","authenticated-orcid":false,"given":"Ahmad","family":"Ahmado","sequence":"additional","affiliation":[{"name":"Ophthalmology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare E","family":"Warrell","sequence":"additional","affiliation":[{"name":"Rare & Imported Pathogens Laboratory (RIPL), UK Health Security Agency, Manor Farm Road, Porton Down, Wiltshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise O","family":"Downs","sequence":"additional","affiliation":[{"name":"Microbiology\/Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Headington, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Furneaux","sequence":"additional","affiliation":[{"name":"Rare & Imported Pathogens Laboratory (RIPL), UK Health Security Agency, Manor Farm Road, Porton Down, Wiltshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karthiga","family":"Sithamparanathan","sequence":"additional","affiliation":[{"name":"Microbiology, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,21]]},"reference":[{"key":"2025082622540570000_15.12.e249426.1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.2005.73.1083"},{"key":"2025082622540570000_15.12.e249426.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2004.01019.x"},{"key":"2025082622540570000_15.12.e249426.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2011.03.019"},{"key":"2025082622540570000_15.12.e249426.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2017\/3769074","article-title":"Severe murine typhus presenting with acalculous cholecystitis: a case report and literature review","volume":"2017","author":"Spernovasilis","year":"2017","journal-title":"Case Rep Med"},{"key":"2025082622540570000_15.12.e249426.5","doi-asserted-by":"crossref","first-page":"172","DOI":"10.3390\/tropicalmed6040172","article-title":"Mediterranean spotted fever: current knowledge and recent advances","volume":"6","author":"Spernovasilis","year":"2021","journal-title":"Trop Med Infect Dis"},{"key":"2025082622540570000_15.12.e249426.6","doi-asserted-by":"crossref","DOI":"10.1186\/s40064-015-1042-3","article-title":"Mediterranean spotted fever: case series of 24 years (1989-2012)","volume":"4","author":"Crespo","year":"2015","journal-title":"Springerplus"},{"key":"2025082622540570000_15.12.e249426.7","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ttbdis.2018.09.001","article-title":"Mediterranean spotted fever rickettsiosis in Italy, 2001-2015: spatio-temporal distribution based on hospitalization records","volume":"10","author":"Gomez-Barroso","year":"2019","journal-title":"Ticks Tick Borne Dis"},{"key":"2025082622540570000_15.12.e249426.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0174745","article-title":"Mediterranean spotted fever in Spain, 1997-2014: epidemiological situation based on hospitalization records","volume":"12","author":"Herrador","year":"2017","journal-title":"PLoS One"},{"key":"2025082622540570000_15.12.e249426.9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.ijid.2015.04.005","article-title":"Mediterranean spotted fever and hearing impairment: a rare complication","volume":"35","author":"Rossio","year":"2015","journal-title":"Int J Infect Dis"},{"key":"2025082622540570000_15.12.e249426.10","doi-asserted-by":"crossref","first-page":"196","DOI":"10.20344\/amp.9713","article-title":"Mediterranean spotted fever in children: study of a Portuguese endemic region","volume":"31","author":"Peixoto","year":"2018","journal-title":"Acta Med Port"},{"key":"2025082622540570000_15.12.e249426.11","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-6-60"},{"key":"2025082622540570000_15.12.e249426.12","unstructured":"Bellissima P , Bonfante S , La Spina G , et al . 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Rickettsial Diseases (Including Spotted Fever & Typhus Fever Rickettsioses, Scrub Typhus, Anaplasmosis, and Ehrlichioses) - Chapter 4 - 2020 Yellow Book | Travelers' Health | CDC, 2021. 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