Leptospirosis with Marked Sinus Bradycardia and Acute Renal Failure: A Case Report and Review of Literature

鉤端螺旋體病由致病性螺旋體引起。偶爾在南亞洲有零星的病例報告。輕微的鉤端螺旋體病只引起類似感冒的症狀，但是在嚴重的狀況下，所謂的“威爾氏病”，將導致急性腎衰竭，高膽紅素血症性肝功能異常，呼吸衰竭，心肌炎及無菌性腦膜炎。死亡多肇因於多器官衰竭。審視文獻報告，鉤端螺旋體病雖然經常引起心臟傳導異常，大約占百分之十的病例，但是並沒有引起竇性心率徐緩的相關報告。本文中，我們提出一鉤端螺旋體病例，初期以急性腎衰竭合併明顯的竇性心律徐緩為表現，稍後由血清搞體檢驗證實此種感染。由此提醒臨床醫師，尤其是感染科及腎臟科、甚至心臟科醫師，若有類似的臨床表現，應警覺此病之可能性。文末並回顧相關文獻報告並做一綜述。

關鍵字

鉤端螺旋體病；竇性心律徐緩；急性腎衰竭

並列摘要

Leptospirosis is an infectious disease caused by pathogenic spirochetes. Occasionally sporadic cases are reported in South Asian. The spectrum of presentation ranges from mild, asymptomatic illness to life-threatening multiple organ dysfunction syndrome (MODS) including renal, liver, and respiratory failure. Associated immune-mediated injury is not rare and manifested as aseptic meningitis or cardiac function abnormality. Mortality is often due to multiple organ failure. In reviewing numerous literatures, though arrhythmias is frequently mentioned, there is actually a lack of in-depth investigation of pathogenesis. Herein, we present a case of leptospirosis with an unusual manifestation of marked sinus bradycardia and review the literatures focusing on similar findings. Despite absence of electrophysiologic studies, its occurence is worthy of discussing its pathogenesis. Also, searching an occult infection is necessary. Due to concomitant renal failure in our case, we also review the literatures discussing and studying renal manifestations. A ”triad” of hyperbilirubinemic hepatic dysfunction, renal failure, and hypotension which implies leptospirosis may be replaced with a new triad of arrhythmias, renal failure and hypotension. And re-positioning spirochete infection as an important cause of acute renal failure, especially in an endemic area, may be necessary.

並列關鍵字

Leptospirosis ； marked sinus bradycardia ； acute renal failure

國際替代計量

Leptospirosis with Marked Sinus Bradycardia and Acute Renal Failure: A Case Report and Review of Literature

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