To the Editor.—
Abdominal involvement is unusual not only in Rocky Mountain Spotted Fever (RMSF), as pointed out by Davis and Bradford in The Journal (1982;247:2811), but also in another milder rickettsiosis, which, surprisingly, has an increased incidence in our country. Boutonneuse fever (BF), caused by Rickettsia conorii, is related to RMSF for several reasons, including a history of tick contact and/or eschar, summer incidence, fever, or characteristic rash.
Report of Cases.—Case 1.—
We have observed1 a case of pancreatic involvement in a 41-year-old man seen in an emergency room for abdominal pain and fever. During the next 24 hours, a characteristic maculopapular rash appeared. In addition, other data provided evidence for the diagnosis as follows: (1) positive serologic test findings (ELISA, positive for specific R conorii antigen and a positive Weil-Felix reaction for Proteus 0X2 antigen), (2) progressive increase of amylasemia (up to 1,000 units/L; reference
Mansueto S, Di Leo R, Tringali G. Unusual Abdominal Involvement in Rickettsial Diseases. JAMA. 1983;249(13):1709–1710. doi:10.1001/jama.1983.03330370023018