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An 81 year-old woman whose chief complaint was fever and general fatigue was admitted to our hospital in Kamiamakusa City, Kumamoto Prefecture in October 2013. She was suspected to have Japanease spotted fever, which is a local pandemic disease in Kamiamakusa, because wide-spreaded skin erythema appeared on the palms of her hands and soles of her feet several days after admission. Though there was a delay of more than 6 days after onset, we treated her with minocycline (MINO) and levofloxacin (LVFX). Unfortunately, she died following the occurrence of disseminated intravascular coagulation (DIC). We could conclude that the delay of proper treatment was most related to her death. In addition, despite of the severity of the disease, cases in whom treatment, survival cases were likely to treat with MINO could be started in the early stage (that is, within 5 days after onset) were likely to survive our hospital. Rickettsia japonica was detected from genetic (PCR analysis from blood and urine) and a serological test in this case. We report herein on the first fatal case of Japanease spotted fever in Kumamoto Prefecture.

First Case Report of Fatal Japanease Spotted Fever in Kumamoto Prefecture and the Investigation of Severe Cases in Kamiamakusa City