A case of Japanese spotted fever complicated with aseptic meningitis and mononeuritis multiplex

Abstract

A 68-year-old woman cleaned the graveyard at the north of Awaji Island in Hyogo prefecture twenty days before admission, and entered the south side of the Rokko Mountains in Hyogo prefecture for tree trimming ten days before admission. She presented with high fever and generalized maculopapular rashes with two eschars on her abdomen in the middle of August. Laboratory studies revealed leukocytosis, thrombocytopenia, hepatic dysfunction, elevated creatine kinase levels and increased levels of anti-Rickettsia japonica antibody titer in the sera. From these results, we diagnosed her as having Japanese spotted fever. After the treatment with minocycline, she developed pain in the back of her neck and disturbance of movement in her extremities, although the eruptions disappeared. We diagnosed her with aseptic meningitis and mononeuritis multiplex based on the cerebrospinal uid analysis and normal brain MRI results. After the treatment with azithromycin and ciprooxacin, these symptoms improved. Five cases of Japanese spotted fever complicated with neurological disorder have been reported previously, and all of them presented with aseptic meningitis. This is the rst case of Japanese spotted fever complicated with both aseptic meningitis and mononeuritis multiplex.