NEW MICROBIOLOGICA, 34, 421-424, 2011 Coronary involvement in Mediterranean spotted fever Antonio Cascio 1 , Maria Cristina Maggio 2 , Francesca Cardella 2 , Valeria Zangara 2 , Salvatore Accomando 2 , Alessandro Costa 3 , Chiara Iaria 4 , Pasquale Mansueto 5 , Salvatore Giordano 6 1 Dipartimento di Patologia Umana, Università di Messina, Messina, Italy; 2 Dipartimento Universitario Materno Infantile, Università di Palermo, Palermo, Italy; 3 Dipartimento di Patologia e Microbiologia Sperimentale, Università di Messina, Messina, Italy; 4 AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive; Italian Association for the Control of Infectious Diseases), University of Messina, Messina, Italy; 5 Unità Operativa Complessa di Medicina Interna, Dipartimento di Medicina Clinica e delle Patologie Emergenti, Università di Palermo, Palermo, Italy; 6 Unità Operativa Complessa di Malattie Infettive, ARNAS “Civico, Di Cristina, Benfratelli”, Palermo, Italy INTRODUCTION Mediterranean spotted fever (MSF) is caused by Rickettsia conorii, which is transmitted by the dog tick Rhipicephalus sanguineus. It is an acute infectious disease typically characterized by fever, skin rash, and a black eschar at the site of tick bite (Raoult and Roux, 1997). Every year, about 300 cases are notified (mainly from June through September) on the Italian island of Sicily (Cascio et al., 2001, Cascio et al., 1998). Sporadic cases have been diagnosed in travelers Corresponding author Prof. Antonio Cascio Programma interdipartimentale di Infettivologia Speciale, Medicina Tropicale e delle Migrazioni e Parassitologia Policlinico “G. Martino” Via Consolare Valeria, 1 - 98125 Messina E-mail: acascio@unime.it in other countries as well (Laurent et al., 2009). We describe the case of a 3-year-old boy with MSF who developed a transient right coronary artery ectasia. CASE REPORT In July 2010 a 3-year-old Italian boy who had pre- viously been healthy was admitted to the pedi- atric emergency clinic of the “G. Di Cristina Children Hospital” with persistent high fever of 4 days duration. In addition, to occasional chills accompanying the fever and mild myalgia of the legs, there were no other complaints, specifical- ly, no nausea, vomiting, or diarrhea, no coughing or dyspnea, and no headaches. Physical exami- nation revealed a temperature of 40°C, a pulse of 104 beats per minute, and a blood pressure of Mediterranean spotted fever (MSF) is a tick-borne acute febrile disease caused by Rickettsia conorii and characterized by fever, a maculo-papular rash and a black eschar at the site of the tick bite. We describe the case of a 3-year-old boy with MSF who developed a transient right coronary artery ectasia. The patient was brought to the hospital after four days of fever and mild myalgia of the legs. The suspicion of MSF arose due to the presence of a maculo-papular skin rash and treatment with oral clarithromycin was started. After four days fever persisted and the differential diagno- sis of Kawasaki syndrome was considered. Echocardiography showed a dilated right coronary artery with hyper- reflective walls. Treatment with intravenous immunoglobulin was initiated while clarithromycin was continued. After one day the fever disappeared. An immunofluorescent antibody test performed after four weeks confirmed a R. conorii infection. A follow-up echocardiography was normal six weeks and six months later. We suggest that ectasia of the coro- nary arteries may be a manifestation of rickettsial vasculitis. Prospective studies are needed to understand the frequency and the possible consequences of this phenomenon in the course of MSF. KEY WORDS: Rickettsia, Ehrlichia, Anaplasma, Spotted fever, Boutonneuse fever, Coronary, Kawasaki syndrome SUMMARY Received March 03, 2011 Accepted July 13, 2011