Widespread subcutaneous necrosis in spotted fever group Rickettsioses from the coastal belt of Sri Lanka- a case report

BMC Infectious Diseases

Case Report

Nathasha Luke¹  Hasini Munasinghe²  Lakshmi Balasooriya²  Ranjan Premaratna³ 

[1] Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka;Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka;Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka;Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka;Department of Medicine, Faculty of Medicine, Ragama, Sri Lanka;

关键词: Spotted fever group rickettsioses;    Skin necrosis;    Purpura fulminans;    Fern leaf rash;    Diagnosis;    Case report;   

DOI  :  10.1186/s12879-017-2375-z

 received in 2016-07-07, accepted in 2017-03-31,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundSpotted fever group rickettsioses (SFGR) transmitted mostly by ticks are increasingly discovered around the World and some of them are either re-emerging or emerging in Sri Lanka. Accidental human infections caused by these vector borne zoonotic diseases generally give rise to nonspecific acute febrile illnesses which can be complicated by multi organ involvement carrying high morbidity and mortality. Nonspecific clinical features and non-availability of early diagnostic facilities are known to result in delay in the diagnosis of rickettsial infections. Therefore, awareness of their prevalence and more importantly their clinical features would be help in the early diagnosis and institution of appropriate therapy.Case presentationA 39-year-old otherwise healthy female presented with an acute febrile illness complicated by severe small joint and large joint arthritis, jaundice, acute kidney injury and disseminated intravascular coagulation (DIC) mimicking palindromic rheumatism or severe sepsis. She later developed a widespread fern-leaf pattern necrotic skin rash with evidence of vasculitis on the palms and soles, aiding the clinical diagnosis of SFGR. She had very high antibody titres against R. conorii antigen confirming the diagnosis and recovered completely with anti-rickettsial therapy.ConclusionWe feel that clinicians should be aware of the unusual clinical presentations such as purpura fulminans and ‘fern-leaf’ pattern necrotic skin rash of SFGR infection. Such knowledge would not only benefit those who practice in tropics with limited diagnostic facilities but also would improve the management of acute febrile illness in returning travelers who visit endemic areas.

【 授权许可】

CC BY   
© The Author(s). 2017