Pardinas Miguel, Mendirichaga Rodrigo, Budhrani Gaurav, Garg Rajan, Rosario Luis, Rico Rene, Panos Anthony, Baier Horst, Krick Stefanie
Division of Internal Medicine, Jackson Memorial Hospital and University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Anesthesiology, Emory University, Atlanta, GA, USA.
Clin Med Insights Circ Respir Pulm Med. 2017 Mar 2;11:1179548416686068. doi: 10.1177/1179548416686068. eCollection 2017.
A 32-year-old man presented with a 10-day history of fever, chills, nausea, vomiting, myalgia, nonproductive cough, and worsening dyspnea after freshwater swimming in the Caribbean 1 week prior to presentation. Shortly after arrival at the hospital, the patient developed severe respiratory distress with massive hemoptysis. Based on serologic workup, he was diagnosed with leptospirosis pulmonary hemorrhage syndrome leading to diffuse alveolar hemorrhage, severe hypoxemic respiratory failure, and multiorgan failure. He received appropriate antibiotic coverage along with hemodynamic support with norepinephrine and vasopressin, mechanical ventilation, and renal replacement therapy in an intensive care unit. Introduction of extracorporeal membrane oxygenation was initiated to provide lung-protective ventilation supporting the recovery of his pulmonary function. Aminocaproic acid was used to stop and prevent further alveolar hemorrhage. He fully recovered thereafter; however, it is uncertain whether it was the use of aminocaproic acid that led to the resolution of his disease.
一名32岁男性患者，在就诊前1周于加勒比海进行淡水游泳后，出现发热、寒战、恶心、呕吐、肌痛、干咳及进行性加重的呼吸困难，病程10天。入院后不久，患者出现严重呼吸窘迫并大量咯血。基于血清学检查，他被诊断为钩端螺旋体病肺出血综合征，导致弥漫性肺泡出血、严重低氧性呼吸衰竭和多器官功能衰竭。在重症监护病房，他接受了适当的抗生素治疗，并接受去甲肾上腺素和血管加压素的血流动力学支持、机械通气及肾脏替代治疗。开始采用体外膜肺氧合以提供肺保护性通气，支持其肺功能恢复。使用氨基己酸来止血并防止进一步的肺泡出血。此后他完全康复；然而，尚不确定是否是氨基己酸的使用导致了他疾病的缓解。
