Weil's disease in a temperate climate: diagnostic uncertainty and the importance of prompt antibiotic treatment.
| Autor: | Arberry J; Acute Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK jamie.arberry@doctors.org.uk., Williams S; Emergency Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK., Abbas M; Intensive Care Medicine, Epsom and Saint Helier Hospital NHS Trust, Carshalton, UK. |
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| Jazyk: | angličtina |
| Zdroj: | BMJ case reports [BMJ Case Rep] 2024 Jul 30; Vol. 17 (7). Date of Electronic Publication: 2024 Jul 30. |
| DOI: | 10.1136/bcr-2024-261771 |
| Abstrakt: | A man in his 50s presents with a short history of rigors, back pain and dark urine. This was associated with scleral icterus. He was initially treated as urosepsis due to perinephric fat stranding on his first CT but continued to deteriorate with worsening sepsis requiring intensive care admission. He had a conjugated hyperbilirubinaemia (peak 708 µmol/L) with normal liver enzymes, anaemia, thrombocytopaenia, acute kidney injury requiring filtration and respiratory failure requiring ventilatory support. A subsequent CT revealed mediastinal lymphadenopathy and extensive ground-glass changes with patchy consolidation. When his history was revisited, exposure to rodents was identified, and serological testing for leptospirosis subsequently came back positive. This case explores the causes of hyperbilirubinaemia in leptospirosis, the dangers of tunnel vision in diagnostic medicine and the importance of prompt antibiotic therapy in Weil's disease. Competing Interests: Competing interests: None declared. (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.) |
| Databáze: | MEDLINE |
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