title: [Clinical reasoning and decision-making in practice. A man with jaundice, renal function disorder, thrombocytopenia, muscular pain and confusion].
abstract: 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.
authors.affiliation: Academisch Ziekenhuis, afd. Intensive Care en Beademing, Interne Kliniek, Postbus 30.001, 9700 RB Groningen.
authors.forename: R M
authors.initials: RM
authors.lastname: Huits
authors.forename: T S
authors.initials: TS
authors.lastname: van der Werf
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D007565:Jaundice / Q000209:etiology / Q000382:microbiology; D007674:Kidney Diseases / Q000209:etiology / Q000382:microbiology; D041383:Leptospira interrogans serovar icterohaemorrhagiae; D008297:Male; D008875:Middle Aged; D013921:Thrombocytopenia / Q000209:etiology / Q000382:microbiology; D016896:Treatment Outcome; D014895:Weil Disease / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D015047:Zoonoses
chemical_list: D000900:Anti-Bacterial Agents