Complications are rare in boutonneuse fever. This is clear from the brief review offered of the relevant literature. Reference is made to the clinical records of a personal series collected in Sicily during the current endemo-epidemic expansion of the disease through some regions of Italy. Primary complications appear in the form of cutaneous vesicles, a pyramidally located psychosensorial syndrome, transient atrial fibrillation and myocardial ischaemia, anuria with hyperazotaemia and another severe renal impairment. Careful clinical investigation of cases with unusual symptoms is recommended, coupled with systematic pathogenetic examination along modern lines.