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Journal of Clinical Microbiology, June 2001, p. 2341-2343, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2341-2343.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Fulminant Japanese Spotted Fever Associated with Hypercytokinemia

Hiromichi Iwasaki,1,* Fumihiko Mahara,2 Nobuhiro Takada,3 Hiromi Fujita,4 and Takanori Ueda5

Division of Transfusion Medicine,1 Department of Immunology and Medical Zoology,3 and First Department of Internal Medicine,5 Fukui Medical University, Fukui, Mahara Hospital, Tokushima,2 and Ohara Research Laboratory, Ohara General Hospital, Fukushima,4 Japan

Received 25 January 2001/Returned for modification 6 March 2001/Accepted 27 March 2001

We report a patient with Japanese spotted fever caused by Rickettsia japonica who developed shock associated with hypercytokinemia. Elevated levels of cytokines (macrophage colony-stimulating factor, interleukin 1 beta, interleukin 10, and gamma interferon) decreased rapidly after a combination treatment using an antibiotic (minocycline hydrochloride [MINO]) and methylprednisolone; however, tumor necrosis factor alpha levels were increased. The patient's fever relapsed and was resolved only after the addition of ciprofloxacin hydrochloride. The administration of new quinolones alone may be another useful form of treatment to eradicate R. japonica even if the symptoms of hypercytokinemia appear to improve with the administration of MINO and methylprednisolone.

* Corresponding author. Mailing address: Division of Transfusion Medicine, Fukui Medical University, 23-3 Shimoaizuki, Matsuoka, Fukui 910-1193, Japan. Phone: 81-776-61-8481. Fax: 81-776-61-8152. E-mail: hiwasaki{at}fmsrsa.fukui-med.ac.jp.

Journal of Clinical Microbiology, June 2001, p. 2341-2343, Vol. 39, No. 6
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.6.2341-2343.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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Copyright © 2001 by the American Society for Microbiology. All rights reserved.