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

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。

 

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.