Ziek na seks en safari in Swaziland

A 35-year-old Dutch man visited our outpatient dermatology clinic with a vesicular rash, accompanied by a sore throat and swollen inguinal lymph nodes. The symptoms started after visiting South Africa and Swaziland, were he once had sexual contact with a local inhabitant. He also went on safari, were he did not note insect bites or stings. In our differential diagnosis were an acute HIV-infection, an imported skin disease (rickettsiosis, for example), a bacterial folliculitis, a streptococcal infection, syphilis, and gonorrhoea. On the basis of the clinical picture and serological investigations, the diagnosis African tick bite fever was made. Our patient received treatment with doxycycline and completely recovered. African tick bite fever is an emerging imported skin disease among travellers.