PDF(Pubmed)
Abstract：
Japanese spotted fever (JSF) is a tick-transmitted infection caused by Rickettsia japonica (R. japonica), which is indigenous to Japan. Patients with JSF typically present with fever and spotted erythema on the palms and/or soles, and most of them have site(s) of tick bites. The prognosis is good, but some cases have a fatal course. Kawasaki disease (KD) is a systemic vasculitis with an unknown cause that is characterized by symptoms such as fever, conjunctival injection, oral findings, amorphous rash, rigid edema, and nonsuppurative cervical lymphadenopathy. Although the symptoms of JSF are partially similar to those of KD, case reports of JSF overlapping KD have never been internationally published. Herein, we report a boy with JSF and KD symptoms. A five-year-old boy presented with fever and rash after he had been on a mountain inhabited by R. japonica. On the fifth day, erythema was spotted mainly on his bilateral palms, bilateral cervical lymphadenopathy, rigid edema of his lower feet, and mild conjunctival injection appeared. Intravenous immunoglobulin (IVIG) therapy was performed because these symptoms satisfied five out of the six diagnostic criteria for KD. However, on the sixth day, the fever persisted, and then we readministered IVIG in addition to tosufloxacin and azithromycin since we found a tick-bite eschar, which suggested a complication of JSF. His symptoms resolved soon after this treatment. Coronary artery lesions were never observed. This case indicates that the R. japonica infection overlaps clinically with KD. Tosufloxacin and azithromycin should be considered to avoid the use of minocycline in younger patients with JSF.
摘要：
日本斑点热（JSF）是由日本立克次体引起的蜱传播感染（R。粳稻)，这是日本本土的。JSF患者通常表现为发烧和手掌和/或脚底有斑点红斑，他们中的大多数都有蜱叮咬的部位。预后良好,但有些病例是致命的.川崎病（KD）是一种病因不明的全身性血管炎，其特征是发热等症状，结膜注射,口头发现，无定形皮疹,刚性水肿，和非化脓性颈部淋巴结肿大。尽管JSF的症状与KD的症状部分相似，JSF重叠KD的病例报告从未在国际上发表。在这里，我们报告了一个有JSF和KD症状的男孩。一个五岁的男孩在被R.japonica居住的山上后出现发烧和皮疹。第五天，红斑主要出现在他的双侧手掌上,双侧颈淋巴结肿大，他的下脚僵硬的水肿，出现轻度结膜注射。进行静脉免疫球蛋白（IVIG）治疗是因为这些症状满足KD的六个诊断标准中的五个。然而,第六天,发烧持续，然后我们除了服用托舒沙星和阿奇霉素之外，还服用了IVIG，因为我们发现了蜱叮咬的焦痂，这表明了JSF的复杂性。他的症状在治疗后不久就消失了。从未观察到冠状动脉病变。该病例表明，日本血吸虫感染在临床上与KD重叠。应考虑在年轻的JSF患者中避免使用托舒沙星和阿奇霉素。
