{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:10:00Z","timestamp":1756321800921,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2018,12,13]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:p>Here, we report a case of a 64-year-old man with severe leptospirosis infected in an area in Japan that is non-endemic to leptospirosis. Initially, findings of high-grade fever, mild generalised arthralgia, rashes on the trunk, mild thrombocytopenia, elevated liver enzymes and renal dysfunction led to the suspicion of rickettsiosis, which was an endemic infectious disease in the area. Subsequently, leptospirosis was also considered after carefully reviewing patient history, which revealed that he may have been exposed to mice urine. Finally, leptospirosis was diagnosed after the serum indicated a positive PCR for leptospirosis. Furthermore, due to serum antibody positivity for <jats:italic>Rickettsia japonica<\/jats:italic>, false-positivity or coinfection of spotted fever rickettsiosis was suspected. Despite the delayed diagnosis, the patient recovered with antibiotic treatment. Thus, to prevent diagnostic errors, leptospirosis should be potentially considered with high suspicion in patients with acute undifferentiated fever, even in non-endemic areas of leptospirosis.<\/jats:p>","DOI":"10.1136\/bcr-2018-226514","type":"journal-article","created":{"date-parts":[[2019,1,11]],"date-time":"2019-01-11T04:27:19Z","timestamp":1547180839000},"page":"bcr-2018-226514","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Severe leptospirosis in a patient with positive serological test for spotted fever rickettsiosis"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6042-7397","authenticated-orcid":false,"given":"Yukinori","family":"Harada","sequence":"first","affiliation":[{"name":"Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minato","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Nagano Central Hospital, Nagano, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,1,10]]},"reference":[{"key":"2025082711280427000_12.1.bcr-2018-226514.1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003866"},{"key":"2025082711280427000_12.1.bcr-2018-226514.2","doi-asserted-by":"publisher","DOI":"10.1089\/vbz.2007.0241"},{"key":"2025082711280427000_12.1.bcr-2018-226514.3","doi-asserted-by":"crossref","first-page":"657","DOI":"10.4269\/ajtmh.2001.65.657","article-title":"Referral pattern of leptospirosis cases during a large urban epidemic of dengue","volume":"65","author":"Flannery","year":"2001","journal-title":"Am J Trop Med Hyg"},{"key":"2025082711280427000_12.1.bcr-2018-226514.4","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.jiac.2013.10.012","article-title":"Leptospirosis in a Japanese urban area: a case report and literature review","volume":"20","author":"Shimizu","year":"2014","journal-title":"J Infect Chemother"},{"key":"2025082711280427000_12.1.bcr-2018-226514.5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.7883\/yoken.JJID.2014.589","article-title":"A comparative study of the epidemiology of human leptospirosis in Korea and Japan between 2006 and 2012","volume":"69","author":"Lee","year":"2016","journal-title":"Jpn J Infect Dis"},{"key":"2025082711280427000_12.1.bcr-2018-226514.6","unstructured":"Leptospirosis in Japan, January 2007-April 2016. IASR;2016:103\u20134."},{"key":"2025082711280427000_12.1.bcr-2018-226514.7","doi-asserted-by":"crossref","first-page":"112","DOI":"10.4269\/ajtmh.2000.62.112","article-title":"Detection of dengue infection in patients investigated for leptospirosis in Barbados","volume":"62","author":"Levett","year":"2000","journal-title":"Am J Trop Med Hyg"},{"key":"2025082711280427000_12.1.bcr-2018-226514.8","doi-asserted-by":"publisher","DOI":"10.1179\/2047773213Y.0000000112"},{"key":"2025082711280427000_12.1.bcr-2018-226514.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00830-2"},{"key":"2025082711280427000_12.1.bcr-2018-226514.10","doi-asserted-by":"crossref","first-page":"89","DOI":"10.4269\/ajtmh.2003.68.89","article-title":"Possible scrub typhus coinfections in Thai agricultural workers hospitalized with leptospirosis","volume":"68","author":"Watt","year":"2003","journal-title":"Am J Trop Med Hyg"},{"key":"2025082711280427000_12.1.bcr-2018-226514.11","doi-asserted-by":"crossref","first-page":"525","DOI":"10.4269\/ajtmh.2007.77.525","article-title":"Coinfection with leptospirosis and scrub typhus in Taiwanese patients","volume":"77","author":"Lee","year":"2007","journal-title":"Am J Trop Med Hyg"},{"key":"2025082711280427000_12.1.bcr-2018-226514.12","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.13-0402"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-226514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:28:13Z","timestamp":1756319293000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-226514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":12,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,10]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bcr-2018-226514"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-226514","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}