A medicane, or Mediterranean cyclone with characteristics similar to tropical cyclones, is simulated using a kilometre-scale ocean–atmosphere coupled modelling platform. A first phase leads to strong convective precipitation, with high potential vorticity anomalies aloft due to an upper-level trough. Then, the deepening and tropical transition of the cyclone result from a synergy of baroclinic and diabatic processes. Heavy precipitation results from uplift of conditionally unstable air masses due to low-level convergence at sea. This convergence is enhanced by cold pools, generated either by rain evaporation or by advection of continental air masses from northern Africa. Back trajectories show that air–sea heat exchanges moisten the low-level inflow towards the cyclone centre. However, the impact of ocean–atmosphere coupling on the cyclone track, intensity and life cycle is very weak. This is due to a sea-surface cooling 1 order of magnitude weaker than for tropical cyclones, even in the area of strong enthalpy fluxes. Surface currents have no impact. Analysing the surface enthalpy fluxes shows that evaporation is controlled mainly by the sea-surface temperature and wind. Humidity and temperature at the first level play a role during the development phase only. In contrast, the sensible heat transfer depends mainly on the temperature at the first level throughout the medicane lifetime. This study shows that the tropical transition, in this case, is dependent on processes widespread in the Mediterranean Basin, like advection of continental air, rain evaporation and formation of cold pools, and dry-air intrusion.