一位47歲男性以咳血為表現之鉤端螺旋體病病例報告

<p>咳血是臨床常見主訴，若併發燒、黃疸、急性肝腎衰竭則增加診斷的困難度。本文是一位47歲男性個案因咳血併發燒，初步診斷細菌性肺炎並高度懷疑肺結核感染後收入院治療，入院24小時內由急性呼吸衰竭進展至急性呼吸窘迫症候群，轉入加護病房插管並使用呼吸器及葉克膜治療。過去病史發現個案大雨後打獵屠宰豬隻時受傷，高度臆測為鉤端螺旋體病，即早投予doxycyline治療，治療後感染指數與肝腎功能逐步改善，住院第9天脫離葉克膜，第17天脫離呼吸器，第18天經血液顯微凝集試驗確診鉤端螺旋體病，個案於住院後第38天出院。臨床上當個案有咳血、發燒、黃疸、合併急性肝腎衰竭時，收集動物接觸史及環境暴觸史至關重要，一旦懷疑鉤端螺旋體病，建議於五天內投予正確之經驗性抗生素治療，可取得治療先機，避免檢驗時效性延誤治療。</p> <p> </p><p>Hemoptysis, though a common clinical complaint, poses diagnostic challenges when accompanied with fever, jaundice, and acute liver and kidney failure. This case study describes a 47-year-old man with hemoptysis and fever. He was initially diagnosed with bacterial pneumonia with a high suspicion of pulmonary tuberculosis and was admitted for treatment. Within 24 hours of hospitalization, he rapidly progressed to acute respiratory failure and subsequently developed acute respiratory distress syndrome (ARDS), necessitating intubation and extracorporeal membrane oxygenation (ECMO) sup-port in the intensive care unit (ICU). Upon reviewing the patient’s history, it was noted that he had sustained an injury while hunting and slaughtering pigs after heavy rainfall, raising a strong suspicion of leptospirosis. Doxycycline was administered immediately, leading to a gradual improvement in in-flammatory markers and liver and kidney function. ECMO support was discontinued on hospital day 9, and the patient was successfully weaned off the ventilator on day 17. On day 18, leptospirosis was con-firmed via a blood microagglutination test. The patient was discharged on day 38. This case highlights the critical importance of obtaining a detailed history of animal exposure and environmental contact in patients presenting with hemoptysis, fever, jaundice, and acute liver and kidney failure. When lep-tospirosis is suspected, initiating appropriate empiric antibiotic therapy within the first five days is strongly recommended to optimize treatment outcomes and prevent delays due to diagnostic testing turnaround time.</p> <p> </p>