1025: Boutonneuse fever: the importance of the clinical findings

M. D. Graure1, A. C. Coman1, F. J. Vera Mendez2, S. Martin Soto1, F. Guillen Cavas1, P. Gea Fernandez1, A. Canovas Ingles1, J. Flores Torrecillas1, T. Kostyrya1, G. M. Peralta Diaz1
1 Cartagena Casco Antiguo Health Centre, Servicio Murciano de Salud, Cartagena, Spain; 2 Infectious Diseases Department, Santa Lucia Hospital, Servicio Murciano de Salud, Cartagena, Spain
Objective: To describe a case of Boutonneuse fever diagnosed only by clinical features.
Methods: Revision of a case of Boutonneuse fever using as main variables the symptoms, tests results, diagnosis, complications, treatment and evolution of the disease.
Results: A 44-year-old man consults for a three days history of abdominal pain, vomiting, high fever, arthromyalgias, generalized papular exanthema with palmoplantar involvement, three pruritic lesions with necrotic Centre on the right leg, bilateral submandibular and inguinal lymphadenopathies and oral mucositis. The blood test shows a C-reactive protein of 15 mg/dl, leukocytosis, while the abdominal X-ray, ultrasound, urine and blood cultures are normal. The serology shows positive IgM for Mycoplasma pneumoniae and Borrelia burgdorferi, the rest being negative, including the IgG and IgM for Rickettsia conorii. Suspecting a Boutonneuse fever, treatment with ceftriaxon and doxycycline is started, but the patient starts with enanthema, oral ulcers, candidiasis and arthritis of the carpal bones. The new chest X-ray confirms an acute interstitial pneumonitis and an intravenous treatment with azithromycin is started, with resolution of the lesions in two weeks. The new serology shows no seroconversion from IgM to IgG thus, the positive results were considered as false positive with final clinical diagnosis of Boutonneuse fever.
Conclusions: High fever, headache, a necrotic crust (tache noire), papular generalised and palmoplantar exanthema, arthromyalgias, hepatosplenomegaly are the main symptoms of Boutonneuse fever. The clinical diagnosis is the most important and immediate treatment with doxycycline should be started to avoid major complications.

Disclosure: No conflict of interest declared