Ludwig Bernd, Zotzmann Viviane, Bode Christoph, Staudacher Dawid L, Zschiedrich Stefan
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Germany.
Department of Medicine III, Faculty of Medicine, University of Freiburg, Germany.
IDCases. 2017 Apr 28;8:84-86. doi: 10.1016/j.idcr.2017.04.016. eCollection 2017.
Human infection with Leptospira interrogans can be life-threatening. Multiple organ involvement frequently presents with liver and kidney failure, less commonly including severe hemolysis and pulmonary hemorrhage syndrome. Here, we present a fulminant case of leptospirosis presenting with hemolysis and pulmonary hemorrhage. A formerly healthy 34 year old patient presented to a rural hospital with dyspnea and hemoptysis after a week of influenza-like symptoms. Initial assessment revealed severe sepsis, acute kidney failure and severe hemolysis. Within the next 29 h, a multi-organ failure developed, which could eventually not be reversed despite mechanical ventilation, venovenous extracorporeal membrane oxygenation, continuous renal replacement therapy, plasmapheresis and extracorporeal cytokine absorbent therapy. The diagnosis of leptospirosis was made after the patient died. The transmitting animal was a pet rat. Leptospirosis has to be considered in case of rapid multi-organ failure presenting with pulmonary hemorrhage.
人感染问号钩端螺旋体可危及生命。多器官受累常表现为肝肾功能衰竭，较少见的包括严重溶血和肺出血综合征。在此，我们报告一例以溶血和肺出血为表现的钩端螺旋体病暴发性病例。一名34岁既往健康的患者在出现一周类流感症状后，因呼吸困难和咯血就诊于一家乡村医院。初始评估显示严重脓毒症、急性肾衰竭和严重溶血。在接下来的29小时内，多器官功能衰竭进展，尽管进行了机械通气、静脉-静脉体外膜肺氧合、持续肾脏替代治疗、血浆置换和体外细胞因子吸附治疗，最终仍无法逆转。患者死亡后确诊为钩端螺旋体病。传播动物为一只宠物鼠。对于出现肺出血的快速多器官功能衰竭病例，必须考虑钩端螺旋体病。
