Mediterranean spotted fever as a non-endemic disease in the southeast of Iran: Diagnosis and treatment based on specific skin lesion

KEY CLINICAL MESSAGE: Rickettsia spp. should be investigated if Tache Noire, as a dark plaque covering a superficial ulcer surrounded by scale, edema, and erythema, are observed, even in non-endemic areas of Rickettsia spp. ABSTRACT: A 31-year-old man with fever, dyspnea, abdominal pain, and jaundice has been admitted to the hospital in the southeast of Iran. Due to the presence of a pathognomonic skin lesion (Tache noire), the patient was diagnosed with Mediterranean spotted fever (MSF) and was treated with doxycycline, without waiting for PCR and IFA findings.