Pertinet findings from the recent NEJM case.
The differential diagnosis includes
Rickettsial diseases are distributed all over the world but Mediterranean spotted fever (MSF), a zoonosis caused by Rickettsia conorii transmitted by the bites of the brown dog tick Rhipicephalus sanguineus, is the most common rickettsiosis occurring in the Mediterranean region. Since the patient did not report a tick bite, I would think this is slightly less likely.
In addition, only a few of the patients with MSF as the patient at NEJM case developed petechiae in the mouth,
"Patients may develop an enanthem known as Koplik's spots; they are considered pathognomonic for measles infection and occur approximately 48 hours before the characteristic exanthem"