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 skin rash is often hemorrhagic and predominantly seen on the extremities. The transmission occurs during the summer season. These make points of difference from Tsutsugamushi disease.