Leptospirosis presenting as haemolytic uraemic syndrome: a case report.
Leptospirosis presenting as haemolytic uraemic syndrome: a case report.
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DOI：
10.1186/s12882-018-0817-5
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发表时间：
2018-01-29
期刊：
影响因子：
2.3
通讯作者：
Blunden MJ
中科院分区：
文献类型：
--
作者：
Muthuppalaniappan VM;Rajakariar R;Blunden MJ
钩端螺旋体病是一种罕见的传染病，尤其是在西方国家。肾脏受累是钩端螺旋体病的公认并发症，但钩端螺旋体病相关的溶血性尿毒症综合征极为罕见，据我们所知，只有一次在1985年被报道一次。
一名29岁的男性因发烧，肌痛和腹泻病被转移到我们的肾部门。实验室研究表明，急性肾脏损伤，急性肝损伤，在血膜上显着升高乳酸脱氢酶，具有明显的贫血，血小板减少症和血块细胞。诊断出溶血性尿毒症综合征。令人惊讶的是，粪便培养是阴性的，导致怀疑钩端螺旋病是鉴别诊断之一。随后通过酶联免疫吸附测定和微观凝集试验来证实这一点。他接受了血浆交换和抗生素，并在出院时完全恢复。
作为溶血性尿毒症综合征表现出的钩端螺旋体病很少见，但在鉴别诊断中应考虑，尤其是在存在重大肝损伤的情况下，正如当前的证据表明该疾病正在重新出现。
Leptospirosis is a rare infectious disease especially in Western Countries. Renal involvement is a recognised complication of leptospirosis but leptospirosis-associated haemolytic uraemic syndrome is extremely rare and to our knowledge has only been reported once, in 1985. A 29-year-old male was transferred to our Renal Unit with fevers, myalgia and diarrhoeal illness. Laboratory investigations revealed an acute kidney injury, acute liver injury, significantly raised lactate dehydrogenase with marked anaemia, thrombocytopenia and schistocytes on a blood film. A diagnosis of haemolytic uraemic syndrome was made. Surprisingly, the stool culture was negative which led to a suspicion of leptospirosis as one of the differential diagnoses. This was subsequently confirmed by enzyme-linked immunosorbent assay and microscopic agglutination test. He received plasma exchange and antibiotics and made a complete recovery on discharge. Leptospirosis presenting as haemolytic uraemic syndrome is rare but should be considered in the differential diagnosis especially in the presence of significant liver injury, as current evidence suggests that the disease is re-emerging.
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