Liver involvement in Tsutsugamushi disease

Tsutsugamushi disease, one of the rickettsiosis, is known to be occasionally accompanied by elevation of hepatic enzyme levels. However, there are only a few reports on histopathological findings of the liver. We presented a case of Tsutsugamushi disease with liver involvement. A 51-year-old man suffered from eruptions and a high fever with a mild transaminasemia. He was diagnosed as Tsutsugamushi disease by detection of IgM class antibody against Rickettsia tsutsugamushi. Laparoscopic examination showed a dark-brown liver with diffuse whitish markings. Microscopic findings were consistent with the features of non-specific reactive hepatitis: sinusoidal small lymphocyte infiltrations, mild disarray of hepatocytes and aggregation of T lymphocytes and macrophages in the lobule.