[Fulminant Japanese spotted fever--the second fatal case in Japan].

A 77-year-old woman who have no past history, was admitted in a local hospital in Muroto City, Kochi, Japan, after several days of fever and severe general fatigue and generalized skin erythema. She was suspected to have Japanease spotted fever, which was a local pandemic disease. She was treated with minocycline immediately. The next day, she had consciousness disturbance and low blood pressure. Laboratory findings indicated disseminated intravascular coagulation (DIC) and multiple organ failure. She was referred to our hospital. An eschar was identified in the back of It. femur. Treatment included minocycline, ciprofloxain, gabexate mesilate, methylprednisolone, hemodialysis and mechanical ventilation. In spite of the avobe treatment, she died 3 days after admission of the local hospital. Though the serological test showed no positive antibody titer against Rickettsia japonica, Rickettsia japonica was isoleted from blood culture, to confirm Japanese spotted fever, Japanese spotted fever is generaly a curative disease with early diagnosis and minocycline. In this case, the patient died 3 days after proper diagnosis and treatment was started. We reported the second fatal Japanese spotted fever case in Japan.