WEILS DISEASE AND NECROTIZING HERPES-SIMP LEX PNEUMONIA AS THE CAUSE OF DEATH IN A 39-YEAR-OLD SEWERAGE WORKER

Acute leptospirosis in Europe (Well's disease) is a rare and in more t han 90% of the cases undiagnosed febrile, self-limited disease. We rep ort the case of a 39-year-old sewerage worker, who was admitted to our hospital with fever, jaundice, pain in his carves and acute renal fai lure. Serology revealed elevated antibody titers against Leptospira ca nicola, L. icterhaemorrhagica and L. sejroe. The patient developed dis seminated intravascular coagulation (DIG) with diffuse gastrointestina l breeding due to thrombocytopenia. The ECG showed atrial fibrillation with irregularly irregular rhythm. Cardiac arrest developed, most lik ely due to hypoxia, with a drop in the blood pressure. Despite immedia te resuscitation efforts the patient developed severe hypoxic brain da mage and died a few days later. Autopsy disclosed histologic signs of a generalized leptospiral infection, signs of shock and within the lun gs a necrotizing herpes simplex virus pneumonia causing the death of t he patient. The virus pneumonia most probably was caused by retrograde canalicular dissemination of oral secretions since herpetic tracheiti s and esophagitis were found and herpetic lesions were readily identif ied on the tips and tongue. A medical opinion asked for by the profess ional association having liability for occupational safety and insuran ce was given, the disease being recognized as an occupational disease.