Abdominal Involvement in Rickettsial Diseases

To the Editor.  —We read with interest the cases reported by Walker et al in the December 1985 issue of the Archives,¹ concerning Rocky Mountain spotted fever (RMSF), its possible presentation as an acute abdomen, and the prognostic implications of postponed treatment due to a delayed adequate diagnosis.We particularly agree with the conclusions of this article and with the editorial by Sexton² in the same issue of the Archives. We present³ a case of Mediterranean spotted fever (MSP, another usually milder rickettsiosis), with an initial diagnosis of "enteritis," inadequate early treatment, and malignant unusual evolution necessitating hemodialysis and mechanical ventilation.The patient initially presented with diarrhea, abdominal pain, and pyrexia, followed by a rash misinterpreted as an adverse reaction to the medications prescribed. Thereafter, the clinical condition worsened with abdominal tenderness and pain in the right upper quadrant of the abdomen (hepatomegaly). The laboratory values showed,