The spotted fever rickettsia, Rickettsia helvetica, is mostly reported to present a flu-like self-limiting disease. In the present case, however, where the presence of R. helvetica in the blood was verified by PCR together with serologic evidence of infection, the patient presented a different clinical picture with acute febrile illness, rash and tong-tasting myasthenia. (C) 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.