Schwerer Verlauf einer Leptospirose mit akutem Nierenversagen und ausgeprägtem Ikterus (Morbus Weil) [A severe course of leptospirosis with acute kidney failure and extensive icterus (Weil disease)]

URN to cite this document:

urn:nbn:de:bvb:355-epub-220449 Copy

DOI to cite this document:

10.5283/epub.22044 Copy

Notheis, W. F. ; Krämer, Bernhard K. ; Leser, H. G. ; Rüschoff, J. ; Kromer, E. P. ; Riegger, G. A. J.

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Date of publication of this fulltext: 08 Sep 2011 06:13

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Details

Item type:	Article
Journal or Publication Title:	Deutsche medizinische Wochenschrift
Publisher:	Thieme
Volume:	118
Number of Issue or Book Chapter:	40
Page Range:	pp. 1437-1441
Date:	1993
Institutions:	UNSPECIFIED
Identification Number:	Value Type 8404498 PubMed ID 10.1055/s-2008-1059471 DOI
Classification:	Notation Type Acute Kidney Injury/therapy MESH Aged MESH Biopsy, Needle MESH Humans MESH Jaundice/etiology MESH Liver/pathology MESH Male MESH Penicillin G/administration & dosage MESH Prognosis MESH Renal Dialysis MESH Weil Disease/drug therapy MESH
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Unknown
Item ID:	22044

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Abstract

A 77-year-old man developed a fever up to 38.4 degrees C, with diarrhoea, acute renal failure (creatinine up to 8.7 mg/dl; urea up to 308 mg/dl) and marked jaundice (total bilirubin up to 24.3 mg/dl). In addition there was thrombocytopenia, conjunctivitis and epistaxis, as well as cerebral symptoms with somnolence and general slowing up. At first he was thought to have cholangitis resulting from ...

Abstract

A 77-year-old man developed a fever up to 38.4 degrees C, with diarrhoea, acute renal failure (creatinine up to 8.7 mg/dl; urea up to 308 mg/dl) and marked jaundice (total bilirubin up to 24.3 mg/dl). In addition there was thrombocytopenia, conjunctivitis and epistaxis, as well as cerebral symptoms with somnolence and general slowing up. At first he was thought to have cholangitis resulting from previously diagnosed gall-stones, and he was therefore treated with ampicillin, 2 g two times daily, and metronidazole, 0.5 g two times daily. The fewer regressed, but the renal failure required haemodialysis and haemofiltration under strict fluid control. Endoscopy excluded obstructive jaundice, but a suspicion of inflammatory liver disease or possibly cirrhosis was raised in the differential diagnosis. Serology revealed an increased titre for Leptospira interrogans var. sejroe (1:200, later 1:1600). Liver biopsy finding was compatible with the diagnosis of leptospirosis. Because of the high inflammatory activity in the liver, 2 mega units of penicillin G were administered three times daily for six days. Gradually the renal functions and jaundice improved and, on discharge on the 36th day, the patient was again in generally good health, although creatinine and bilirubin values were still slightly elevated (1.7 mg/dl each).

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