병력 청취와 신체 검사가 중요함을 시사한 쯔쯔가무시병

Abstract

Tsutsugamushi disease is an acute febrile illness that is caused by infection with Orientia tsutsugamushi. The diagnosis is based on the patient’s history of exposure, the characteristic clinical features and serologic testing. But the diagnosis can be difficult when an eschar is overlooked or it is absent. Making the differential diagnosis with drug eruption is especially difficult when a skin rash develops with a prior medication history for fever or myalgia. We report here on 3 cases of Tsutsugamushi disease. Two of the cases were misdiagnosed as drug eruption due to medication for carbuncle or back pain. For the other case, Tsutsugamushi disease was accompanied with allergic contact dermatitis due to Rhus (lacquer tree). All the patients had fever, myalgia and an atypical skin rash that differed from that of drug eruption and allergic contact dermatitis. The detection of eschar was possible by having a clinical suspicion of Tsutsugamushi disease. Thus, we report here on three cases of Tsutsugamushi disease and these cases show the importance of taking a complete medical history and performing a thorough physical examination.