Abstract
INTRODUCTION: Mediterranean spotted fever is an infection caused by Rickettsia conorii that is endemic to the Mediterranean basin. It is mainly transmitted by ticks. The association between this infection and Guillain-Barre syndrome (GBS) is uncommon. OBSERVATION: We present the case of a 29-year-old Tunisian patient with no prior medical conditions who presented with flaccid quadriplegia that progressed to respiratory distress. This was accompanied by persistent fever and hepatosplenomegaly. Acute motor axonal GBS was diagnosed through electroneuromyography, and R. conorii infection was diagnosed through serology. Treatment with immunoglobulins and doxycycline led to gradual clinical improvement. CONCLUSION: This case underscores the importance of considering R. conorii infection in patients with GBS presenting with systemic symptoms, especially in endemic regions like Tunisia.