Abstract
Japanese spotted fever and scrub typhus (Tsutsugamushi disease) are two representative forms of rickettsiosis commonly seen in Japan. We report a case of Japanese spotted fever and a case of scrub typhus, both of which developed at the same time of season. We focused on the differences in clinical manifestations and treatments between these two similar disorders. Case 1 : A 59-year-old woman admitted to our hospital with complaints of general myalgia, high fever and rash on August 2009. She had a mild fever with fatigue lasting for a week before the consultation. Examination identified two papules with central necrosis on her lower back. Disseminated erythema was observed on her trunk and extremities, including both palms. Lymphadenopathy was absent. A blood test showed elevation of C-reactive protein, thrombocytopenia and hepatic dysfunction. Since Japanese spotted fever was suspected, treatments with intravenous minocycline and oral levofloxacin were started. All the symptoms disappeared in 2 weeks following these treatments. Diagnosis was confirmed by the elevated titers of specific antibody in the serum against Rickettsia japonica. Case 2 : A 59-year-old man was referred to our department because of high fever and rash on August 2009. Examination identified a necrotic ulcer on his right back. Disseminated erythema was observed on his trunk and extremities but not in the palms. Computed tomography (CT) revealed generalized lymphadenopathy in the axillae, para-aortic and abdominal nodes. Under a tentative diagnosis of scrub typhus, he was treated with intravenous minocycline. All the symptoms disappeared in approximately 2 weeks by the treatment. A final diagnosis was made by the elevated serum levels of IgM specific for Orientia tsutsugamushi.
