Two Cases of Misdiagnosis of Acute Appendicitis in a Patient with Hemorrhagic Fever with Renal Syndrome and a Patient with Tsutsugamushi Disease

ABSTRACT

Both tsutsugamushi disease and hemorrhagic fever with renal syndrome frequently cause abdominal pain with tenderness; therefore they are occasionally misdiagnosed as surgical abdomen. Two patients presented with symptoms of acute abdomen, and under the suspicion of acute appendicitis they underwent appendectomies. Nevertheless there were no operative findings of acute appendicitis in both patients, and the clinical conditions were deteriorated after the operation. Acute infectious disease was suspected by thrombocytopenia, elevated liver enzymes, and proteinuria. Indirect immunoflourescence test confirmed tsutsugamushi disease and hemorrhagic fever with renal syndrome, respectively. The patient with tsutsugamushi disease improved with administration of doxycycline and the patient with hemorrhagic fever with renal syndrome spontaneously improved.