Benoit Patrick, Meehan Marie-Eve, Chapdelaine Hugo, Vincent Catherine, Sirdar Emmanuel, Savard Patrice, Nguyen Bich N, Luong Me-Linh
Department of Medicine, Service of Internal Medicine, Université de Montréal, Montréal, Québec, Canada.
Department of Pathology and Cellular Biology, Université de Montréal, Montréal, Québec, Canada.
J Assoc Med Microbiol Infect Dis Can. 2019 Nov 29;4(4):248-251. doi: 10.3138/jammi.2019-0008. eCollection 2019 Dec.
A 25-year-old man presented to the emergency department with a 3-day history of fever, anorexia, jaundice, and a generalized skin eruption. His liver function tests showed marked cholestatic and cytolytic abnormalities without liver insufficiency. A liver biopsy was performed, and morphology with routine stains was considered non-specific. Because of the dermatological findings, the non-specific biopsy morphology, and the absence of an identified infectious etiology, a diagnosis of Kawasaki disease was presumed. However, additional colorations on liver biopsy with Warthin-Starry stain revealed multiple thin and coiled microorganisms compatible with spirochetes. His serology for leptospirosis was found to be positive for IgM, supporting the diagnosis of acute leptospirosis with liver involvement. Our case illustrates the diagnostic challenge of leptospirosis and highlights the utility of conventional laboratory tests to confirm the diagnosis. Exceptionally, Warthin-Starry stain allowed the identification of leptospires in liver biopsy and confirmed liver involvement of systemic leptospirosis.
一名25岁男性因发热、厌食、黄疸及全身性皮疹3天就诊于急诊科。他的肝功能检查显示明显的胆汁淤积和细胞溶解性异常，但无肝功能不全。进行了肝脏活检，常规染色的形态学表现被认为是非特异性的。由于有皮肤病学表现、非特异性活检形态学以及未发现明确的感染病因，推测诊断为川崎病。然而，肝脏活检经沃辛-斯塔瑞染色后发现多个与螺旋体相符的细而盘绕的微生物。他的钩端螺旋体病血清学检查发现IgM呈阳性，支持急性钩端螺旋体病伴肝脏受累的诊断。我们的病例说明了钩端螺旋体病的诊断挑战，并强调了传统实验室检查对确诊的实用性。特别的是，沃辛-斯塔瑞染色能够在肝脏活检中识别钩端螺旋体，并证实了系统性钩端螺旋体病的肝脏受累情况。
