# Administration of Corticosteroids for Prompt Suppression of Cytokine Storm in Severe Cases of Japanese Spotted Fever

## TL;DR

This case study shows that corticosteroids can help control severe immune reactions in Japanese spotted fever when used with antibiotics.

## Contribution

Demonstrates successful cytokine storm suppression in severe Japanese spotted fever using corticosteroids alongside antibiotics.

## Key findings

- Intravenous hydrocortisone reduced inflammatory cytokines and improved clinical outcomes in a severe JSF case.
- Corticosteroid treatment was associated with decreased DIC markers and stabilized blood pressure.
- Combination therapy with antibiotics and corticosteroids may be effective in managing severe JSF.

## Abstract

Japanese spotted fever (JSF) is a tick-borne disease caused by Rickettsia japonicaand primarily affects the warmer coastal areas of Japan. Early treatment with tetracycline antibiotics is crucial to prevent severe complications, such as pneumonia, meningitis, disseminated intravascular coagulation (DIC), and systemic inflammatory response syndrome. An 83-year-old man with hypertension, chronic kidney disease, and hyperuricemia presented with DIC and subsequently developed septic shock. Polymerase chain reaction confirmed JSF caused by R. japonica. Initial treatment with ceftriaxone was ineffective, leading to a switch to intravenous minocycline and levofloxacin. Considering the high levels of C-reactive protein, procalcitonin, ferritin, and soluble interleukin-2 receptor, intravenous hydrocortisone (200 mg/day) was administered to control the cytokine storm. On day 4, the patient’s condition improved significantly, with increased blood pressure, reduced DIC markers, and decreased levels of inflammatory cytokines, including interleukin-6 and tumor necrosis factor-α. The patient’s recovery continued, and he was transferred to a chronic care hospital. Severe JSF cases are primarily driven by a cytokine storm caused by an excessive immune response. Early administration of corticosteroids along with antibiotics effectively suppressed the cytokine storm in this case. Reports have shown mixed results, indicating the need for further research to determine the optimal type, dosage, and duration of corticosteroid treatment.