Fulminant Japanese spotted fever associated with hypercytokinemia

We report a patient with Japanese spotted fever caused by Rickettsia japoni ca who developed shock associated with hypercytokinemia. Elevated levels of cytokines (macrophage colony-stimulating factor, interleukin 1 beta, inter leukin 10, and gamma interferon) decreased rapidly after a combination trea tment using an antibiotic (minocycline hydrochloride [MINO]) and methylpred nisolone; however, tumor necrosis factor alpha levels were increased. The p atient's fever relapsed and was resolved only after the addition of ciprofl oxacin hydrochloride. The administration of new quinolones alone may be ano ther useful form of treatment to eradicate R. japonica even if the symptoms of hypercytokinemia appear to improve with the administration of MINO and methylprednisolone.