Department of General Internal Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, 1211, Geneva, Switzerland.
J Med Case Rep. 2021 Jul 23;15(1):358. doi: 10.1186/s13256-021-02978-0.
Leptospirosis is an underdiagnosed bacterial infection with nonspecific symptoms, hence, a diagnostic challenge. Identifying a case of leptospirosis in Switzerland is uncommon. Although kidney complications are frequent in severe forms, including tubular dysfunction, observing this complication is rare in our country. We report the case of a patient with leptospirosis and kidney dysfunction, which was notable for proximal tubulopathy. This case report describes the diagnosis and management of this patient's tubular dysfunction.
A 34-year-old Caucasian male known for alcohol and drug abuse presented to our emergency department suffering from severe pain in the lower limbs, jaundice, and fever with flu-like symptoms. Physical examination was not contributory. Blood tests showed cytopenia, elevated inflammatory markers, acute kidney injury, and altered liver function tests with predominant cholestasis. Urinalysis showed proteinuria and significant glycosuria without concomitant hyperglycemia. Leptospirosis was suspected and confirmed by both positive serum polymerase chain reaction and elevated immunoglobulin M for Leptospira interrogans. The patient was treated with intravenous amoxicillin-clavulanate and doxycycline for 7 days. After antibiotic treatment, symptoms disappeared, and kidney dysfunction completely resolved.
Our case focuses on the description of leptospirosis-related acute kidney injury with proximal tubular dysfunction, which is a rare finding in Switzerland.
钩端螺旋体病是一种具有非特异性症状的诊断不足的细菌感染，因此具有诊断挑战性。在瑞士，识别钩端螺旋体病病例并不常见。尽管肾脏并发症在严重形式中很常见，包括管状功能障碍，但在我国观察到这种并发症很少见。我们报告了一例钩端螺旋体病和肾功能障碍的患者，其特点是近端肾小管病变。本病例报告描述了该患者管状功能障碍的诊断和治疗。
一名 34 岁的白人男性，有酗酒和吸毒史，因下肢剧烈疼痛、黄疸和流感样症状发热就诊于我院急诊科。体格检查无明显异常。血液检查显示细胞减少、炎症标志物升高、急性肾损伤和肝功能检查异常，以胆汁淤积为主。尿液分析显示蛋白尿和明显的糖尿，但无伴随的高血糖。怀疑为钩端螺旋体病，并通过血清聚合酶链反应阳性和血清免疫球蛋白 M 升高证实。患者接受了 7 天的静脉用阿莫西林克拉维酸和强力霉素治疗。抗生素治疗后，症状消失，肾功能完全恢复。
我们的病例重点描述了在瑞士罕见的钩端螺旋体病相关急性肾损伤伴近端肾小管功能障碍。
