Leptospirosis and Jarisch–Herxheimer reaction

Learning points for clinicians Although not commonly seen in Japan, the incidence of leptospirosis reported in 2014 was the highest in the past 6 years. It is important to consider leptospirosis among patients who traveled to Okinawa, Japan, and to keep in mind Jarisch–Herxheimer reaction when administering antimicrobial agents to patients with leptospirosis. Case report A 59-year-old Japanese man with a history of hypertension pre-sented with a complaint of fever and watery diarrhea. He climbed mountains, got lost accidentally and drunk 2 l of fresh water in the swamp in Okinawa, Japan 2 weeks prior to admission. Physical examinations showed blood pressure 129/ 89 mmHg, heart rate 112/min, respiratory rate 30/min, tempera