Tomacruz Isabelle Dominique, Sandejas Joanne Carmela, Berba Regina, Sacdalan Dennis Raymond
Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
Division of Infectious Diseases, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
BMJ Case Rep. 2019 Aug 30;12(8):e230619. doi: 10.1136/bcr-2019-230619.
Neurological manifestations of leptospirosis without severe multiorgan involvement are a rare clinical entity. Despite the increasing prevalence of the disease in many tropical countries, its protean clinical presentations make its timely diagnosis challenging. We report the case of a 44-year-old Filipino man presenting with fever, myalgia, behavioural changes and altered sensorium. Neurological examination did not show any focal neurological deficits or clear signs of meningoencephalitis. Lumbar tap, cranial CT scan and cranial MRI were inconclusive. The diagnosis of leptospirosis with acute encephalitis relied heavily on the patient's clinical clues, appropriate exposure history and patterns in ancillary laboratory tests. Empiric antibiotic therapy with ceftriaxone was initiated. Seroconversion and fourfold increase in serological antibody titres by leptospirosis microagglutination test later confirmed the diagnosis. The patient was successfully treated, and all neurological complications were reversed.
无严重多器官受累的钩端螺旋体病的神经表现是一种罕见的临床实体。尽管该病在许多热带国家的发病率不断上升，但其多样的临床表现使其及时诊断具有挑战性。我们报告一例44岁菲律宾男性病例，该患者出现发热、肌痛、行为改变和意识改变。神经系统检查未发现任何局灶性神经功能缺损或明确的脑膜脑炎体征。腰椎穿刺、头颅CT扫描和头颅MRI均无定论。钩端螺旋体病合并急性脑炎的诊断很大程度上依赖于患者的临床线索、适当的接触史以及辅助实验室检查结果。开始使用头孢曲松进行经验性抗生素治疗。随后通过钩端螺旋体病微量凝集试验血清学转换及血清抗体滴度四倍升高确诊。患者得到成功治疗，所有神经并发症均得到逆转。
