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Japanese spotted fever associated with multiorgan failure.

K Kodama1, T Senba, H Yamauchi

  • 1Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo 656-0013, Japan. kodama@awaji-hosp.sumoto.hyogo.jp

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|January 26, 2002
PubMed
Summary

Severe Japanese spotted fever can be fatal. Combination therapy with minocycline and short-term steroids effectively treated a patient with multiple organ failure, improving consciousness and reducing inflammation.

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Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Immunology

Background:

  • Japanese spotted fever is a severe rickettsial infection.
  • Multiple organ failure and disseminated intravascular coagulation (DIC) are critical complications.
  • Elevated soluble interleukin 2-receptor (sIL2-R) indicates severe immune activation.

Observation:

  • A 49-year-old male presented with high fever, rash, and eschar, progressing to multiple organ failure, shock, and coma.
  • Initial treatment included minocycline, anti-thrombin III, heparin, and hemodialysis.
  • Rapid improvement in fever and consciousness occurred after a single dose of methylprednisolone.

Findings:

  • The patient was diagnosed with severe Japanese spotted fever (Rickettsia japonica).

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  • Markedly elevated sIL2-R levels suggested hypercytokinemia and lymphocyte activation.
  • Combination therapy with minocycline and short-term corticosteroids was crucial for recovery.

    • Implications:

    • Early recognition and aggressive treatment are vital for severe rickettsial infections.
    • Combination therapy may be more effective than minocycline alone in critical cases.
    • Short-term corticosteroid use can mitigate hyperinflammation in severe spotted fever.