Topical treatment with incision and antiseptic may prevent the severity of Japan spotted fever

Dear Editor, A 72-year-old woman presented with sudden pain and bean-sized red nodule on the lower abdomen. She had high fever and consulted Ise Municipal Hospital as an emergency outpatient. She had a custom of binding up leafs at the shrine. The diagnosis was clinically made as cellulitis. Computed tomography (CT) showed the edema on the lesion, and the right inguinal lymph node swelling was observed (Fig. 1), suggesting cellulitis. Local incision with drainage and antiseptic topical treatment with povidone iodine were performed on the lesion (Fig. 2). The patient was treated with i.v. ceftriaxone sodium (CTRX). However, the lesions did not respond to CTRX, and a fever of over 39 C persisted. Five days after the onset, the patient noticed circular erythema on the whole body. In addition, palmar erythema was found and an eschar was observed near the incision.