Cardiac involvement in a patient with clinical and serological evidence of African tick-bite fever

Abstract

Background: Myocarditis and pericarditis are rare complications of rickettsiosis, usually associated with Rickettsia rickettsii and R. conorii. African tick-bite fever (ATBF) is generally considered as a benign disease and no cases of myocardial involvement due to Rickettsia africae, the agent of ATBF, have yet been described.

Case presentation: The patient, that travelled in an endemic area, presented typical inoculation eschars, and a seroconversion against R. africae, was admitted for chest pains and increased cardiac enzymes in the context of an acute myocarditis.

Conclusion: Our findings suggest that ATBF, that usually presents a benign course, may be complicated by an acute myocarditis.

Figure 1

Travel of patient A and his wife in South Africa and Swaziland and description of key events, signs and symptoms.

Figure 2

Skin lesions (patient A): 2A. vesicular erythematous rash of both legs; 2B. one inoculation eschar on the abdomen.

Figure 3

Electrocardiograms performed (A) at admission and (B) 6 hours later: repolarisation abnormalities not present initially are present in the inferior leads of the 2^nd electrocardiogram.