Lawrence I G, Dalby R J, Lad N R, Shepherd R J
Department of Medicine, Leicester General Hospital.
Br J Clin Pract. 1996 Sep;50(6):346-8.
A 23-year-old man, previously fit and well, presented with an atypical pneumonia, associated with microangiopathic anaemia, thrombocytopenia, rhabdomyolysis and renal impairment. Despite administration of intravenous fluids and antibiotics, his condition rapidly deteriorated, and the possibility of an aggressive connective tissue disorder was raised. Thus he was treated with high-dose oral steroids and plasma exchange until autoantibodies were shown to be negative. At this stage it transpired that the patient had swallowed water from a stream three weeks earlier, and leptospira antibody titres were subsequently found to be elevated. Antibiotics were continued, and after a protracted course he made a full recovery. Leptospirosis should be remembered as a rare cause of atypical pneumonia, particularly if there is associated hepatic or renal impairment.
一名23岁的男性，既往身体健康，出现了非典型肺炎，伴有微血管病性贫血、血小板减少、横纹肌溶解和肾功能损害。尽管给予了静脉补液和抗生素治疗，但其病情迅速恶化，于是考虑可能患有侵袭性结缔组织病。因此，他接受了大剂量口服类固醇和血浆置换治疗，直到自身抗体检测呈阴性。此时发现该患者三周前饮用了溪水，随后检测到钩端螺旋体抗体滴度升高。继续使用抗生素治疗，经过漫长的病程后他完全康复。钩端螺旋体病应被视为非典型肺炎的罕见病因，尤其是在伴有肝或肾功能损害的情况下。
