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表现为HELLP(溶血、肝酶升高和血小板减少)综合征的钩端螺旋体病:妊娠期罕见的钩端螺旋体病病例

Leptospirosis Manifesting as HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome: A Rare Case of Leptospirosis During Pregnancy.

作者信息

Patel Twisha, Pajai Sandhya, Patel Nidhi, Patel Parth

机构信息

Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND.

Medical Education and Simulation, Sumandeep Vidyapeeth, Vadodra, IND.

出版信息

Cureus. 2023 May 16;15(5):e39083. doi: 10.7759/cureus.39083. eCollection 2023 May.

Abstract

Pregnancy is characterized by a reduced immune response, making pregnant women more susceptible to infections. We present a case of a 24-year-old woman in her second pregnancy who arrived at the hospital at 36 weeks gestation in active labor. The patient had received regular antenatal care including routine prenatal check-ups, screenings, and appropriate vaccinations. She complained of abdominal pain for 5-6 hours, sudden onset of hematuria, and a history of low-grade fever for two days. Physical examination revealed paleness, grade three pedal edema, and elevated blood pressure. Diagnostic tests showed mild anemia, thrombocytopenia, proteinuria, elevated liver enzymes, and kidney dysfunction. The patient was admitted to the labor ward, and a tentative diagnosis of hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome was made. Shortly after arrival, she spontaneously delivered a healthy baby. However, post-delivery, her fever profile indicated the presence of leptospira IgM antibodies, leading to a diagnosis of leptospirosis mimicking HELLP syndrome. Immediate medical treatment resulted in symptom resolution within two weeks and normal biochemical values within a month. Leptospirosis, caused by the gram-negative spirochete bacteria leptospira, is a zoonotic infection rarely observed during pregnancy and can be misdiagnosed due to its atypical presentation. It can mimic other pregnancy-related conditions such as viral hepatitis, obstetric cholestasis, HELLP syndrome, and acute fatty liver of pregnancy. Early detection and treatment are crucial as this disease can have serious consequences for both the mother and fetus. Therefore, leptospirosis should be considered a potential differential diagnosis, particularly in endemic areas.

摘要

怀孕的特征是免疫反应降低,这使得孕妇更容易受到感染。我们报告一例24岁的二胎孕妇病例,她在妊娠36周时因规律宫缩入院待产。该患者接受了常规的产前检查,包括定期的产前检查、筛查和适当的疫苗接种。她主诉腹痛5-6小时,突然出现血尿,并有两天的低热病史。体格检查发现面色苍白、三级足背水肿和血压升高。诊断检查显示轻度贫血、血小板减少、蛋白尿、肝酶升高和肾功能不全。患者被收入产房,初步诊断为溶血、肝酶升高和血小板减少(HELLP)综合征。入院后不久,她自然分娩出一个健康的婴儿。然而,产后她的发热情况显示存在钩端螺旋体IgM抗体,导致诊断为酷似HELLP综合征的钩端螺旋体病。立即进行药物治疗,两周内症状缓解,一个月内生化指标恢复正常。钩端螺旋体病由革兰氏阴性螺旋体细菌钩端螺旋体引起,是一种在孕期很少见的人畜共患病感染,因其非典型表现可能会被误诊。它可以酷似其他与妊娠相关的疾病,如病毒性肝炎、产科胆汁淤积症、HELLP综合征和妊娠急性脂肪肝。早期发现和治疗至关重要,因为这种疾病对母亲和胎儿都可能产生严重后果。因此,钩端螺旋体病应被视为一种潜在的鉴别诊断,特别是在流行地区。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/79e5/10269396/f0a63109055a/cureus-0015-00000039083-i01.jpg

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