Pansitopeni ile Yoğun Bakıma Yatırılan Hastada Nadir Bir Etiyoloji: Leptosipoz
Özet
Leptosipiroz kontamine su, enfekte hayvan idrarı ve dokularına temas ile bulaşan bir zoonozdur. Klinik olarak olguların büyük bir kısmı kendini sınırlayıcı özellik taşırken bazı olgularda çoklu organ yetmezliği gelişebilir ve bu durum potansiyel olarak ölümcül seyredebilmektedir. Bu olgu sunumunda, daha önceinde komorbitidesi olmayan genç bir kadında pansitopeni ile seyreden leptospiroz tablosu bildirilmektedir. Hasta, ateş, miyalji ve vücut döküntüsü yakınmaları ile yaşadığı bölgedeki bir sağlık kuruluşuna başvurmuş sonrasında ise hasta yakınlarının isteği üzerine kendi imkânları ile hastanemize başvurmuştur. Septik şok ve solunum yetmezliği tanıları ile entübe edilip yoğun bakım ünitemize kabul edildi. Öyküde köyde çiftçlikle ve toprak ile uğraştığı ve ayırıcı tanıda bir özellik saptanmayınca leptospirozdan şüphelenilmiştir. Serolojik incelemeler, Leptospira interrogans serovar Icterohaemorrhagiae strain Wijnberg infeksiyonunu doğrulamıştır. Yoğun destek tedavilerine rağmen hemodinamik instabilite ve çoklu organ yetmezliği süreci hızla ilerledi. Hasta yatırılışının ikinci gününde exitus oldu. Bu olgu, leptospirozun nadir hematolojik bir bulgusu olan pansitopeniyi ortaya koymakta ve endemik olmayan bölgelerde bile mesleki maruziyet öyküsü bulunan hastalarda erken dönemde leptospirozun akılda tutulması gerektiğini vurgulamaktadır.
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