RICKETTSIAL (TYPHUS) FEVER - SIMULTANEOUS OCCURRENCE OF LEFT-VENTRICULAR THROMBUS AND SINGLE-VESSEL CORONARY-DISEASE

A 44-year-old German fell ill in Libya, where he had been living for 1 0 years, with high fever, rigor and a nonitching centrifugally spreadi ng macular rash, which had spared the head, hands and soles. In additi on, a systolic cardiac murmur was heard. The Weil-Felix reaction had a titre rising within 3 days from 1 : 160 to 1 : 640, confirming the di agnosis of rickettsial disease, the total clinical picture indicating typhus. On treatment with chloramphenicol (1 g three times daily i.v.) the fever subsided within 5 days. On the ninth day treatment was chan ged to oral doxycyclin, 200 mg daily for 3 weeks. Echocardiography sur prisingly revealed a floating thrombus, about 4 x 8 cm, attached to th e hypo- and even akinetic apex of the left ventricle. In addition ther e was single-vessel coronary disease. Since the segmental contraction abnormality persisted after the typhus had been cured, a causal connec tion with the rickettsial disease is unlikely. The thrombus was remove d at the time of a aortocoronary bypass operation: his course has been unremarkable since then.