title: [Weil's disease and necrotizing herpes pneumonia as the cause of death of a 39-year-old sewage drain worker].
abstract: Acute leptospirosis in Europe (Weil's disease) is a rare and in more than 90% of the cases undiagnosed febrile, self-limited disease. We report the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his calves and acute renal failure. Serology revealed elevated antibody titers against Leptospira canicola, L. icterhaemorrhagica and L. sejroe. The patient developed disseminated intravascular coagulation (DIC) with diffuse gastrointestinal bleeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most likely due to hypoxia, with a drop in the blood pressure. Despite immediate resuscitation efforts the patient developed severe hypoxic brain damage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lungs a necrotizing herpes simplex virus pneumonia causing the death of the patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheitis and esophagitis were found and herpetic lesions were readily identified on the lips and tongue. A medical opinion asked for by the professional association having liability for occupational safety and insurance was given, the disease being recognized as an occupational disease.
authors.affiliation: Abteilung Allgemeine Pathologie, Universität, Freiburg i. Br.
authors.forename: M
authors.initials: M
authors.lastname: Bek
authors.forename: H
authors.initials: H
authors.lastname: Köppl
authors.forename: G
authors.initials: G
authors.lastname: Schwarzkopf
authors.forename: N
authors.initials: N
authors.lastname: Freudenberg
mesh_terms: D000328:Adult; D002423:Cause of Death; D004211:Disseminated Intravascular Coagulation / Q000473:pathology; D006561:Herpes Simplex / Q000473:pathology*; D006801:Humans; D008168:Lung / Q000473:pathology; D008297:Male; D009336:Necrosis; D009784:Occupational Diseases / Q000473:pathology*; D011024:Pneumonia, Viral / Q000473:pathology*; D012722:Sewage / Q000382:microbiology; D014895:Weil Disease / Q000473:pathology*
chemical_list: D012722:Sewage
vernacular_title: Weil'sche Erkrankung und nekrotisierende Herpespneumonie als Todesursache bei einem 39 Jahre alt gewordenen Kanalarbeiter.