Harada Yukinori, Hayashi Minato
Diagnostic and Generalist Medicine, Dokkyo Medical University, Shimotsuga-gun, Japan.
Nagano Central Hospital, Nagano, Japan.
BMJ Case Rep. 2019 Jan 10;12(1):bcr-2018-226514. doi: 10.1136/bcr-2018-226514.
Here, we report a case of a 64-year-old man with severe leptospirosis infected in an area in Japan that is non-endemic to leptospirosis. Initially, findings of high-grade fever, mild generalised arthralgia, rashes on the trunk, mild thrombocytopenia, elevated liver enzymes and renal dysfunction led to the suspicion of rickettsiosis, which was an endemic infectious disease in the area. Subsequently, leptospirosis was also considered after carefully reviewing patient history, which revealed that he may have been exposed to mice urine. Finally, leptospirosis was diagnosed after the serum indicated a positive PCR for leptospirosis. Furthermore, due to serum antibody positivity for , false-positivity or coinfection of spotted fever rickettsiosis was suspected. Despite the delayed diagnosis, the patient recovered with antibiotic treatment. Thus, to prevent diagnostic errors, leptospirosis should be potentially considered with high suspicion in patients with acute undifferentiated fever, even in non-endemic areas of leptospirosis.
在此，我们报告一例64岁男性感染严重钩端螺旋体病的病例，该患者在日本一个非钩端螺旋体病流行地区感染。最初，高热、轻度全身关节痛、躯干皮疹、轻度血小板减少、肝酶升高和肾功能不全的表现导致怀疑为立克次体病，该病是该地区的一种地方性传染病。随后，在仔细回顾患者病史后也考虑到了钩端螺旋体病，病史显示他可能接触过鼠尿。最后，血清钩端螺旋体病PCR检测呈阳性后确诊为钩端螺旋体病。此外，由于血清抗体对 呈阳性，怀疑斑点热立克次体病存在假阳性或合并感染。尽管诊断延迟，但患者经抗生素治疗后康复。因此，为防止诊断错误，即使在非钩端螺旋体病流行地区，对于急性未分化发热患者也应高度怀疑钩端螺旋体病。
