Endocrine Abstracts

Introduction: Rickettsia diseases are infectious, re-emerging, polymorphic, potentially fatal diseases that are widespread worldwide. These are diseases caused by strict intracellular bacteria with a Gram-negative stain associated with arthropods, mainly ticks, but also lice, fleas and other mites. In diabetics, adequate and early management is essential given the risk of developing malignant Mediterranean spotted fever.

Observation: We report the case of a 69-year-old patient, known to be type 2 diabetic for 13 years, well balanced on 1 g/d of metformin (HBA1C at 6.9%) and who consulted for a fever associated with a generalized rash evolving since 1 week with intense myalgia and asthenia. Clinical examination revealed a maculopapular rash and a pressure ulcer spot. Laboratory workup demonstrated thrombocytopenia, lymphopenia, inflammatory syndrome with elevated CRP, hepatic cytolysis and glycemic imbalance. The treatment consisted of antibiotic therapy and insulin therapy with good clinical and biological progress.

Discussion and conclusion: The diabetic subject can present a polymorphic clinical picture of rickettsioses associating an infectious syndrome which is sometimes severe, a skin rash and a disturbance of the biological assessment with thrombocytopenia and hepatic cytolysis as the case of our patient. This observation underscores the value of early and adequate management in diabetics in order to avoid multisystem involvement that can be life-threatening.