Boignard A, Bonadona A, Hamidfar R, Pavese P, Bouvaist H, Hammer L, Rey I, Schwebel C, Vanzetto G, Barnoud D
Unité de réanimation médicale, Fédération des maladies cardiovasculaire et thoraciques, CHU de Grenoble, BP 217, 38043 Grenoble 9.
Arch Mal Coeur Vaiss. 2006 Mar;99(3):251-4.
A 48 year old man was admitted to the intensive care unit with septicaemic shock associated with febrile jaundice and anuric renal failure. Within hours, he developed cardiogenic shock with multi-organ failure due to an acute myocarditis refractory to catecholamines and requiring intra-aortic balloon pumping. The diagnosis was an ictero-haemorrhagic leptospirosis, the outcome of which was finally favourable. Myocarditis is an underestimated complication of leptospirosis because it is often symptomless. The main signs are arrhythmias, conduction defects and ST-T wave abnormalities which have little clinical expression. The disease may progress and is sometimes fatal. Leptospirosis myocarditis should therefore be carefully considered because of its potential severity and its reversibility with appropriate antibiotic therapy and also the necessity of initial management in a specific infrastructure.
一名48岁男性因与发热性黄疸和无尿性肾衰竭相关的败血症性休克入住重症监护病房。数小时内，他因急性心肌炎发展为心源性休克并伴有多器官功能衰竭，该急性心肌炎对儿茶酚胺无反应，需要进行主动脉内球囊泵血。诊断为黄疸出血型钩端螺旋体病，最终预后良好。心肌炎是钩端螺旋体病一种被低估的并发症，因为它通常没有症状。主要体征是心律失常、传导缺陷和ST-T波异常，临床表现不明显。该病可能进展，有时会致命。因此，由于钩端螺旋体病心肌炎潜在的严重性以及通过适当抗生素治疗可逆转，同时也鉴于在特定设施中进行初始治疗的必要性，应仔细考虑该病。
