Naik B Kishansing, Sulakshana Sulakshana, Gopaldas Justin Aryabhat, Devvrat Sai
Department of Critical Care, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.
Department of Anaesthesiology and Critical Care, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.
Indian J Crit Care Med. 2022 Mar;26(3):387-389. doi: 10.5005/jp-journals-10071-24137.
We report a case of fulminant hepatic failure due to the Budd-Chiari syndrome following preservation with a tropical fever. A young lady came with fever, altered mental status, jaundice, and renal failure. Following tropical workup, it was diagnosed as a case of leptospirosis (WHO Faine's criteria) with multi-organ dysfunction. Despite adequate antimicrobial cover, she progressed to hepatic coma (hyperammonemia) and was noted to have worsening conjugated hyperbilirubinemia. Following history review and evaluation for other causes of hepatic failure, hepatic vein thrombosis was detected in addition to the presence of antibodies against antigen. Further studies into the causes of thrombosis and persistent hemoconcentration despite aggressive fluid resuscitation led to the diagnosis of polycythemia vera (cytometric analysis). During her stay, she further worsened despite aggressive organ support including dialysis but she succumbed to gram-negative sepsis that occurred during her stay in ICU. This is an interesting and rare case of leptospirosis that unveiled a case of previously asymptomatic polycythemia vera.
Naik BK, Sulakshana S, Gopaldas JA, Devvrat S. Tropical Fever: Unveiling an Asymptomatic Case of Polycythemia Vera. Indian J Crit Care Med 2022;26(3):387-389.
我们报告一例因热带热后布加综合征导致的暴发性肝衰竭病例。一名年轻女性因发热、精神状态改变、黄疸和肾衰竭前来就诊。经过热带病检查，诊断为钩端螺旋体病（世界卫生组织费内标准）伴多器官功能障碍。尽管给予了充分的抗菌治疗，她仍进展为肝昏迷（高氨血症），并出现结合胆红素血症加重。在回顾病史并评估肝衰竭的其他原因后，除发现针对该抗原的抗体外，还检测到肝静脉血栓形成。对血栓形成原因及尽管积极进行液体复苏仍持续存在血液浓缩的进一步研究导致诊断为真性红细胞增多症（细胞计数分析）。在她住院期间，尽管包括透析在内的积极器官支持，她的病情仍进一步恶化，但最终死于重症监护病房期间发生的革兰阴性菌败血症。这是一例有趣且罕见的钩端螺旋体病病例，揭示了一例先前无症状的真性红细胞增多症病例。
奈克BK，苏拉克沙娜S，戈帕尔达斯JA，德夫拉特S。热带热：揭示一例无症状真性红细胞增多症病例。《印度危重症医学杂志》2022年；26(3):387 - 389。
