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Severe leptospirosis in a patient with positive serological test for spotted fever rickettsiosis
  1. Yukinori Harada1 and
  2. Minato Hayashi2
  1. 1 Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan
  2. 2 Nagano Central Hospital, Nagano, Japan
  1. Correspondence to Dr Yukinori Harada, yuki.gym23{at}


Here, we report a case of a 64-year-old man with severe leptospirosis infected in an area in Japan that is non-endemic to leptospirosis. Initially, findings of high-grade fever, mild generalised arthralgia, rashes on the trunk, mild thrombocytopenia, elevated liver enzymes and renal dysfunction led to the suspicion of rickettsiosis, which was an endemic infectious disease in the area. Subsequently, leptospirosis was also considered after carefully reviewing patient history, which revealed that he may have been exposed to mice urine. Finally, leptospirosis was diagnosed after the serum indicated a positive PCR for leptospirosis. Furthermore, due to serum antibody positivity for Rickettsia japonica, false-positivity or coinfection of spotted fever rickettsiosis was suspected. Despite the delayed diagnosis, the patient recovered with antibiotic treatment. Thus, to prevent diagnostic errors, leptospirosis should be potentially considered with high suspicion in patients with acute undifferentiated fever, even in non-endemic areas of leptospirosis.

  • tropical medicine (infectious disease)
  • infectious diseases

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  • Contributors All authors have approved of the submission. YH drafted the first version of the manuscript. MH revised it critically for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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