Japanese spotted fever (JSF) was first reported in 1984 as an emerging rickettsiosis caused by Rickettsia japonica [1]. It is characterized by high fever (99 %), skin rash (94 %), and eschar formation (66 %) [2], and is clinically similar to other rickettsioses, especially scrub typhus. Neurological complications in rickettsiosis, including aseptic meningitis, meningoencephalitis, myelitis, polyradiculoneuritis, Guillain Barré syndrome, and facial nerve paralysis, occur in 2–5% of patients [3] and are usually associated with systemic manifestations. However, sensorineural hearing loss is uncommon in rickettsiosis, and JSF complicated by sensorineural hearing loss has been rarely reported.

Leukocytoclastic vasculitis is a small-vessel vasculitis with leukocytoclasis, which can be observed under various conditions, such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, connective tissue disease, and infections [4]. Some cases of leukocytoclastic vasculitis have been described in rickettsiosis [[5], [6], [7], [8]] and are believed to be the result of vascular endothelial inflammation caused by rickettsial infection of these cells. However, deposition of the immune complex in vessel walls has rarely been reported in rickettsiosis.

Herein, we report a case of JSF complicated by acute sensorineural hearing loss and presenting with cutaneous IgM/IgG immune complex vasculitis.