PMID- 38333512
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240210
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 16
IP  - 1
DP  - 2024 Jan
TI  - A Japanese Boy With Spotted Fever and Overlapping Symptoms of Kawasaki Disease: A 
      Case Report.
PG  - e51915
LID - 10.7759/cureus.51915 [doi]
LID - e51915
AB  - 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.
CI  - Copyright (c) 2024, Sasaki et al.
FAU - Sasaki, Kosuke
AU  - Sasaki K
AD  - Department of Community Medicine, Shimane Prefectural Central Hospital, Himebara, 
      JPN.
FAU - Yamada, Kenji
AU  - Yamada K
AD  - Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, JPN.
AD  - Department of Pediatrics, Shimane Prefectural Central Hospital, Himebara, JPN.
FAU - Matama, Chihiro
AU  - Matama C
AD  - Department of Pediatrics, Shimane Prefectural Central Hospital, Himebara, JPN.
FAU - Koike, Daisuke
AU  - Koike D
AD  - Department of Pediatrics, Shimane Prefectural Central Hospital, Himebara, JPN.
FAU - Hirade, Tomohiro
AU  - Hirade T
AD  - Department of Pediatrics, Shimane Prefectural Central Hospital, Himebara, JPN.
FAU - Mashino, Junji
AU  - Mashino J
AD  - Department of General Medicine, Shimane Prefectural Central Hospital, Himebara, 
      JPN.
FAU - Kato, Fumihide
AU  - Kato F
AD  - Department of Pediatrics, Shimane Prefectural Central Hospital, Himebara, JPN.
FAU - Taketani, Takeshi
AU  - Taketani T
AD  - Department of Pediatrics, Shimane University Faculty of Medicine, Izumo, JPN.
LA  - eng
PT  - Case Reports
DEP - 20240108
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10850932
OTO - NOTNLM
OT  - azithromycin
OT  - japanese spotted fever
OT  - kawasaki disease
OT  - rickettsia japonica
OT  - tosufloxacin
COIS- The authors have declared that no competing interests exist.
EDAT- 2024/02/09 06:42
MHDA- 2024/02/09 06:43
PMCR- 2024/01/08
CRDT- 2024/02/09 04:01
PHST- 2024/01/06 00:00 [accepted]
PHST- 2024/02/09 06:43 [medline]
PHST- 2024/02/09 06:42 [pubmed]
PHST- 2024/02/09 04:01 [entrez]
PHST- 2024/01/08 00:00 [pmc-release]
AID - 10.7759/cureus.51915 [doi]
PST - epublish
SO  - Cureus. 2024 Jan 8;16(1):e51915. doi: 10.7759/cureus.51915. eCollection 2024 Jan.