A Case of Japanese Spotted Fever Misdiagnosed as COVID-19 on Admission

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  • SHIRAISHI Kenichiro
    Department of Infectious diseases, Shimonoseki City Hospital Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences
  • NODA Takahiro
    Department of Cardiology, Shimonoseki City Hospital
  • HASHIMOTO Sawako
    Department of Dermatology, Shimonoseki City Hospital
  • UCHIDA Hiroshi
    Department of Dermatology, Shimonoseki City Hospital
  • KIKUCHI Tetsuya
    Infection Control Committee, Shimonoseki City Hospital
  • OTANI Kazuhiro
    Infection Control Committee, Shimonoseki City Hospital
  • YOSHIDA Junichi
    Infection Control Committee, Shimonoseki City Hospital
  • TANAKA Masao
    Infection Control Committee, Shimonoseki City Hospital
  • SHIMONO Nobuyuki
    Center for the Study of Global Infection, Kyushu University Hospital
  • AKASHI Koichi
    Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences

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Other Title
  • COVID-19としての入院診療中に，日本紅斑熱と診断し救命し得た1例

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<p>COVID-19 is manifested by various symptoms and needs to be distinguished from other diseases. We report the case of a patient with Japanese spotted fever (JSF) who was admitted with a diagnosis of COVID-19. The patient was a 72-year-old woman with high fever whose SARS-CoV-2 rapid antigen test was positive. She also had rashes on her trunk and extremities, including on her palms and soles. We treated her as a COVID-19 patient, viewing her rashes as a complication of COVID-19 or a drug eruption. However, her fever and rashes persisted. Her medical history revealed a history of mowing, which involves a high risk of tick bites, and we discovered an eschar on her left popliteal fossa. We then suspected JSF and treated her with intravenous minocycline and levofloxacin as a severe case. PCR testing of specimens from the eschar was positive for Rickettsia japonica. A confirmatory SARS-CoV-2 PCR test and an anti-nucleocapsid antibody test were negative. We ultimately diagnosed the patient with JSF, not COVID-19. The number of JSF patients in Japan has increased in recent years. Since the clinical presentation of JSF patients and COVID-19 patients is similar, a careful medical history and physical examination are necessary to make the differential diagnosis.</p>

Journal

  • Kansenshogaku Zasshi

    Kansenshogaku Zasshi 97 (2), 69-74, 2023-03-20

    The Japanese Association for Infectious Diseases

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