Clinical reasoning and decision-making in practice. a man with jaundice, renal function disorder, thrombocytopenia, muscular pain and confusion
Huits, R.M.; van der Werf, T.S.; Zijlstra, J.G.
Nederlands Tijdschrift Voor Geneeskunde 148(23): 1137-1141
2004
ISSN/ISBN: 0028-2162 PMID: 15211963 Document Number: 576678
A 51-year-old man became jaundiced, after experiencing flu-like symptoms for a week. On admission anaemia, thrombocytopenia, and hepatic and renal function disorders were present. One month previously he had had sinusitis. Thrombotic thrombocytopenic purpura (TTP)/haemolitic-uraemic syndrome (HUS) was suspected, but the thrombocyte count rose spontaneously. The leukocytosis indicated an infectious cause of the symptoms and the jaundice appeared to originate from intrahepatic cholestasis. All symptoms could be traced to leptospirosis icterohaemorrhagica (known as 'Weil's disease'). The source was possibly the patient's fishpond. He recovered spontaneously and was also treated with antibiotics. Leptospirosis, a multi-organ disease is seen ever more infrequently as an occupational disease in stock farmers and increasingly frequently in people whose hobbies involved animals.