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BMJ Case Reports 2012; doi:10.1136/bcr-2012-007295
  • Reminder of important clinical lesson

Gangrene in cases of spotted fever: a report of three cases

  1. Suresh Kumar3
  1. 1Department of Internal Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
  2. 2Department of Infectious Diseases and Internal Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
  3. 3Department of Critical Care Medicine, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India
  1. Correspondence to Dr Harshal Satish Joshi, drhsj83{at}rediffmail.com

Summary

Gangrene is an uncommon complication in cases of rickettsial spotted fever. We report three cases of spotted fever from south India, presumably caused by Rickettsia conorii subspecies indica. Along with gangrene, these cases had severe manifestations of sepsis and multiorgan dysfunction syndrome (MODS) like acute kidney injury, liver dysfunction, delirium and seizure. One patient died while the other two recovered well. This case series is being reported to highlight the occurrence of gangrene in spotted fever rickettsiosis and the importance of appropriate management at the earliest.

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