Abstract
Japanese spotted fever was first reported in 1984 in Tokushima Prefecture，and around 300 cases have been reported annually． In our department，we experienced 6 cases with this disease between April and October in 2020． Herein，we report the clinical features and abnormal laboratory findings． Among its triad of fever，skin rash and bite spot，the former two were observed in all 6 cases，whereas the bite spot was observed in 3 cases． As the clinical appearance of this disease is similar to that of febrile toxic rash，drug eruption or cutaneous vasculitis，sometimes it is difficult to diagnose，if the bite spot is missing． Moreover，fatal cases have been reported due to multiple organ failure followed by disseminated intravascular coagulation syndrome．
In recent years，the number of the cases are increasing not only in western，but also in eastern part of Japan in accordance with expansion of the distribution area of rickettsia-transmitting ticks． It is important to take notice of laboratory findings，social history，and lifestyle of patients and the epidemic area of Japanese spotted fever in addition to triad of symptoms to confirm the diagnosis without delay．
