Case 169. Japanese spotted fever (38 y-o F)

　 　 　 　
　 Hemorrhagic skin spots on the trunk and extremities in a Tokushima resident presenting high fever and thrombocytopenia (biopsy from the leg) 　
　 　 　 　

　

 　 The eschar (the site of mite bite) in Japanese spotted fever is smaller than in Tsutsugamushi disease (gross findings). Rickettsia japonica is transmitted by a larva of the tick Hamoaphysalis flava.