DOI: 10.36347/sjmcr.2017.v05i11.034

Pages: 801-804

An 84-year-old female who had difficulty moving due to left hip joint pain after falling down was admitted to the Department of Orthopedics of our hospital. She had a history of operation of myoma uteri. On arrival, she had diffuse spotted erythemas in her body with a high fever (39.0 °C) and high levels of C-reactive protein (CRP) and fibrin degradation products (FDP) in addition to femur neck fracture. Orthopedicians focused on the fracture. She remained febrile and experienced thrombocytopenia progression, but she underwent internal fixation and was treated by cefazolin on the third hospital day. On the fifth hospital day in the evening, she developed labored breathing, followed by convulsion and unstable circulation. She underwent tracheal intubation and was transferred to the intensive-care unit. She was suspected of having Rickettsiae or a severe fever with thrombocytopenia syndrome. She underwent treatment with minocycline, new-quinolone, vasopressors, steroids, gamma globulin and renal replacement therapy for acute renal failure on the sixth day, but multiple organ failure with disseminated intravascular coagulation deteriorated her condition and resulted in her death on the seventh hospital day. On the same day, Rickettsia japonica was detected by an analysis of polymerase chain reaction from her blood and urine at a public health center. This is the fourth fatal case of Japanese spotted fever (JSF). Physicians should pay attention to increased levels of CRP or FDP on arrival in traumatized patients. Furthermore, if patients have skin lesion, thrombocytopenia or signs of inflammation, appropriate treatment for Rickettsiae diseases, including JSF, should be started immediately.