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He reported an insect bite 2 days before the start of the symptoms while he was hunting on a farm in Jaén (south of Spain). The patient could not identify the insect that caused the bite. Later, he developed a non-pruritic erythematous wheal lesion in the right armpit that, within days, progressed to a round necrotic eschar with an erythematous halo around it (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), associated with a generalized non-pruritic erythematosus rash with palmoplantar involvement. Given the clinical suspicion of Mediterranean spotted fever, treatment with doxycycline was initiated at a dose of 100<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h, with fever resolution and improvement of the general state. IgM serology was positive for <span class="elsevierStyleItalic">Rickettsia conorii two days after his visit to the emergency department.</span> Diagnostic confirmation was made by performing PCR for <span class="elsevierStyleItalic">Rickettsia</span> in the biopsy of the black spot.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Fernández-Bravo I, Demelo-Rodríguez P, Alejandre de Oña Á, del Toro Cervera J. Mancha negra o «tache noire» en la fiebre botonosa mediterránea. 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Journal Information
Vol. 151. Issue 3.
Pages 130 (August 2018)
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Vol. 151. Issue 3.
Pages 130 (August 2018)
Image in medicine
Black spot or “tache noire” in Mediterranean spotted fever
Mancha negra o «tache noire» en la fiebre botonosa mediterránea
Irene García-Fernández-Bravo
, Pablo Demelo-Rodríguez, Álvaro Alejandre de Oña, Jorge del Toro Cervera
Corresponding author
Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
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