Japanese spotted fever associated with multiorgan failure.
A 49-year-old man was admitted to our hospital, with a diagnosis of multiple organ failure, on June 10, 2000. Physical examination revealed high fever, generalized maculopapular erythema, and an eschar on his lower leg. Laboratory findings revealed severe renal and liver dysfunction, disseminated intravascular coagulation (DIC), and markedly elevated soluble interleukin 2-receptor (sIL2-R) level (>10 000 U/ml). Administration of minocycline was started immediately, with a diagnosis of rickettsial infection. Simultaneously, anti-thrombin III and heparin were started to treat the DIC, and hemodialysis was also initiated. However, the day after admission, his consciousness level lapsed, to the level of coma, and blood pressure was less than 60 mmHg, indicating shock. Therefore, 500 mg of methylprednisolone was administered once; as a result, rapid pyretolysis and improvement of consciousness disturbance were achieved. Laboratory data indicative of inflammation gradually improved after a few days. Hemodialysis was required ten times. During the recovery period, the level of specific IgM antibody against Rickettsia japonica increased to x2560, and he was diagnosed as having Japanese spotted fever. On July 11, he was discharged without sequelae. The course in our patient was very severe, and treatment with minocycline alone may have resulted in a fatal outcome. The level of sIL2-R, which is produced by activated lymphocytes, was markedly increased. Therefore, markedly elevated lymphocyte activation and hypercytokinemia may have been present on admission. The short-term steroid therapy may have been effective in inhibiting the excessive activation of lymphocytes in the critical stage. In the severe form of Japanese spotted fever with organ failure, combination therapy with minocycline and short-term steroids may be very useful.
Kodama
K
K
Department of Internal Medicine, Hyogo Prefectural Awaji Hospital, Sumoto, Hyogo 656-0013, Japan. kodama@awaji-hosp.sumoto.hyogo.jp
Senba
T
T
Yamauchi
H
H
Chikahira
Y
Y
Fujita
H
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D015375:Receptors, Interleukin-2 / Q000097:blood; D012281:Rickettsia / Q000276:immunology; D012282:Rickettsia Infections / Q000150:complications* / Q000188:drug therapy; D012698:Serologic Tests
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000907:Antibodies, Bacterial; D007075:Immunoglobulin M; D015375:Receptors, Interleukin-2; D008911:Minocycline; D008775:Methylprednisolone