以發燒、黃疸與急性腎衰竭為表現之重症型鉤端螺旋體病Weil's Disease（威爾氏症）

Severe Leptospirosis (Weil's Disease) with Fever, Jaundice and Acute Renal Failure: A Case Report

陳美萍(May-Pin Chen) ； 張力仁(Li-Jen Chang) ； 陳金凰(Chin-Huang Chen) ； 卓惠伶(Hui-Ling Cho) ； 陳煒(Wei Chen)

《台灣專科護理師學刊》 6卷2期 (2019/12) Pp. 66-70

摘要

病人同時合併發燒、黃疸和急性腎衰竭等症狀常是臨床上棘手的狀況，需要考慮到各樣的可能性。本案例是一位66歲的男性農夫在大雨過後發燒合併有黃疸與急性腎衰竭的現象，原本被認為是膽道感染，經電腦斷層檢查無異狀，並其雨天暴露及農夫的背景，經顯微凝集試驗才診斷為重症型鉤端螺旋體病Weil's disease（威爾氏症）。在病人接受抗生素治療14天後，腎功能逐漸恢復，黃疸指數也有下降。因此，當遇到個案有同時合併發燒、黃疸、急性腎功能惡化，加上又有風災水患或野外活動接觸史時，必須將鉤端螺旋體病列為鑑別診斷，以免喪失治療先機。

關鍵字

發燒 ； 黃疸 ； 急性腎衰竭 ； 鉤端螺旋體病 ； Weil's disease

並列摘要

It is considered a critical condition when a patient presents with fever, jaundice and acute renal failure. A 66-year-old male farmer presented with such critical condition after heavy rain. Biliary tract infection was suspected initially, but the computed tomography of his abdomen showed no abnormality. Because of his history of skin exposure to rain water and his occupation as a farmer, leptospirosis was suspected. Later on, icteric leptospirosis (Weil's disease) was diagnosed through a positive result of the microscopic agglutination test. After 14 days of antibiotic treatment, renal function and jaundice recovered gradually. Therefore, when a patient presents with fever, jaundice and renal function deterioration, as well as an exposure history of heavy rain, flood or outdoor activity, leptospirosis should be taken into consideration.

並列關鍵字

fever ； jaundice ； acute renal failure ； leptospirosis ； Wilson's diseas

參考文獻

李志雄、莊峰榮、陳靖博、許國泰（2004）．鉤端螺旋體感染造成的腎病變．腎臟與透析，16（3），179-183。doi:10.6340/KD.2004(3).13

Gulati, S., & Gulati, A. (2012). Pulmonary manifestations of leptospirosis. Lung India: Official Organ of Indian Chest Society, 29(4), 347-353. doi:10.4103/0970-2113.102822

Herath, N. J., Kularatne, S. A., Weerakoon, K. G., Wazil, A., Subasinghe, N., & Ratnatunga, N. V. (2014). Long term outcome of acute kidney injury due to leptospirosis? A lon-gitudinal study in Sri Lanka. BMC Research Notes, 7(1), 398. doi:10.1186/1756-0500-7-398.

Maroun, E., Kushawaha, A., El-Charabaty, E., Mobarakai, N., & El-Sayegh, S. (2011). Fulminant Leptospirosis (Weil’s disease) in an urban setting as an overlooked cause of multiorgan failure: a case report. Journal of Medical Case Reports, 5(1), 7. doi:10.1186/1752-1947-5-7.

Rosenfeld, G. A., Chang, A., Poulin, M., Kwan, P., & Yoshida, E. (2011). Cholestatic jaundice, acute kidney injury and acute pancreatitis secondary to the recreational use of methan-drostenolone: A case report. Journal of Medical Case Re-ports, 5(1), 138. doi:10.1186/1752-1947-5-138