Mediterranean spotted fever, a diagnostic challenge in travellers.

Mediterranean spotted fever or boutonneuse fever is caused by Rickettsia conorii and transmitted by the brown dog tick. The commonest symptoms are pyrexia, a maculopapular rash, lymphadenopathies and an inoculation eschar. Increasingly, it is recognised as a cause of serious illness in southern Europe. Rickettsial infections of the spotted fever group are rarely reported in Belgium. We report the case of a 20-year-old traveller returning from Morocco who presented with fever and a markedly swollen inguinal lymph node. Our case report illustrates the challenges rickettsioses can pose to physicians facing febrile travellers. Awareness of the epidemiology and the spectrum of clinical manifestations of this acute zoonosis can help physicians to promptly start appropriate empiric antibiotic therapy.