Kobayashi Keigo, Baba Haruna, Takeda Riki, Nishiyama Susumu, Nakamoto Shu, Umekawa Yasuhiro
Department of Internal Medicine, Kurashiki Medical Center, Japan.
Center for Postgraduate Medical Training, Kurashiki Medical Center, Japan.
Intern Med. 2025 Jul 15;64(14):2249-2254. doi: 10.2169/internalmedicine.4813-24. Epub 2024 Dec 26.
A woman in her late 70s presented with a fever, rashes, and marked proximal muscle weakness. Noninfectious conditions, including myositis and vasculitis, were initially considered. Treatment with cephalosporins was ineffective, but the symptoms improved with minocycline, indicating possible Japanese spotted fever (JSF) despite no apparent history of tick exposure. The diagnosis was confirmed by serological tests. A skin biopsy revealed leukocytoclastic vasculitis with immune complex deposition, suggesting muscle damage due to immune complexes. This case underscores the need to consider JSF in patients with atypical symptoms and initiate timely treatment to prevent severe complications.
一名70多岁的女性出现发热、皮疹和明显的近端肌无力。最初考虑了包括肌炎和血管炎在内的非感染性疾病。使用头孢菌素治疗无效，但米诺环素治疗后症状有所改善，尽管没有明显的蜱虫叮咬史，但仍提示可能为日本斑点热（JSF）。血清学检测确诊了该诊断。皮肤活检显示白细胞破碎性血管炎伴免疫复合物沉积，提示免疫复合物导致肌肉损伤。该病例强调了对于有非典型症状的患者需要考虑JSF，并及时开始治疗以预防严重并发症。
