A 51-year-old Japanese woman presented with a high-grade fever, headache, malaise, and right leg pain that had worsened over 5 days. A tender, continuous streaking erythema from a peeled off eschar between the toes to the inside of the right lower leg was observed (Picture 1A, B), with maculopapular rashes on the thighs (Picture 2). On visit, a polymerase chain reaction test for Rickettsia japonica in a blood sample was negative, and immunoglobulin G titers by indirect immunofluorescence assay were ＜1:20; however, they had increased to 1:320 at 3 weeks later, suggesting a clinical diagnosis of Japanese spotted fever (JSF) based on epidemiological factors. Minocycline and levofloxacin were administered intravenously. Acute lymphangitis-associated rickettsiosis is characteristic of R. sibirica mongolotimonae and is usually accompanied by eschars and a moderate/high-grade fever (1). Only one case of JSF with lymphangitis has been reported in Japan (2). Clinicians should consider JSF in patients with acute lymphangitis, eschar, and a fever in endemic regions.
Picture 1.
Picture 2.
Written informed consent was obtained from the patient for the publication of this article and accompanying images. A copy of the written consent form is available for review by the editor-in-chief of the journal upon request.
The authors state that they have no Conflict of Interest (COI).
References
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