Muthuppalaniappan Vasantha Muthu, Rajakariar Ravindra, Blunden Mark John
Department of Renal Medicine and Transplantation, The Royal London Hospital, Barts Health NHS Trust, London, UK.
William Harvey Research Instititute, Queen Mary University of London, London, UK.
BMC Nephrol. 2018 Jan 29;19(1):20. doi: 10.1186/s12882-018-0817-5.
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.
钩端螺旋体病是一种罕见的传染病，尤其在西方国家。肾脏受累是钩端螺旋体病公认的并发症，但钩端螺旋体病相关的溶血尿毒综合征极为罕见，据我们所知，仅在1985年有过一次报道。
一名29岁男性因发热、肌痛和腹泻被转入我们的肾脏科。实验室检查显示急性肾损伤、急性肝损伤、乳酸脱氢酶显著升高，伴有明显贫血、血小板减少和血涂片上出现裂体细胞。诊断为溶血尿毒综合征。令人惊讶的是，粪便培养为阴性，这导致怀疑钩端螺旋体病为鉴别诊断之一。随后通过酶联免疫吸附试验和显微镜凝集试验得以确诊。他接受了血浆置换和抗生素治疗，出院时完全康复。
以溶血尿毒综合征形式出现的钩端螺旋体病很罕见，但在鉴别诊断中应予以考虑，尤其是在存在明显肝损伤的情况下，因为目前有证据表明该病正在重新出现。
