급성 췌장염을 동반한 중증의 렙토스피라증 1예 = A Case of Weil's Disease associated with Acute Pancreatitis

다국어 초록 (Multilingual Abstract)

Leptospirosis is a zoonotic disease of worldwide distribution that is caused by spirochetes known as Leptospira; more than 20 serogroups and more than 200 serovars are known. The disease has seasonal incidence occurring in the late summer or early fall. The typical severe case of leptospirosis is known as Weil's disease; it is characterized by hepatic and renal involvement and is common in Korea. Elevated amylase can be seen when ARF is associated but true acute pancreatitis is an uncomon complication of leptospirosis and only seven cases of well documented pancreatitis have been described abroad, with there was no case report in Korea yet. We experienced a 55-year old male patient who had Weil's disease associated with acute pancreatitis which was confirmed by elevated amylase and lipase with pancreatic swelling and peripancreatic fat infiltration on abdomen CT.

국문 초록 (Abstract)

렙토스피라증은 전세계적으로 분포하는 인수공통질환으로 Leptospira로 알려진 스피로헤타가 원인균이며 늦여름이나 초가을에 발생하는 급성 열성질환으로, 간이나 신장을 침범하는 중증형을 Weil's disease라고 하는데, 국내에서는 이 임상형태가 흔한 편이다. 급성 신부전이 동반될 경우 혈청 아밀라아제의 증가가 있을 수 있으나, 급성 췌장염은 드문 합병증으로 되어 있고 외국에서는 7예의 급성췌장염이 동반된 사례의 보고가 있었으나 국내에서는 아직까지 보고된 예가 없었다.
이에 저자들은 Weil's disease를 진단받은 55세 남자환자에서 혈청 아밀라아제 및 리파아제가 급격히 증가하고 복부전산화 단층촬영상 췌장부종 및 췌장주위 지방조직의 침윤으로 급성 췌장염이 확인된 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

참고문헌 (Reference)

1 "한국의 렙토스피라증에 관한 연구현황" 31 : 569-70, 1987

2 "최근 4년간 광주,전남지역에서 발생한 렙토스피라병 155예" 42 : 239-45, 1992

3 "전투경찰에서 발생한 렙토스피라병 12예 대한 역학 및 임상적 고찰" 61 : 553-561, 2001

4 "신부전증과 신병증이 동반된 렙토스피라증의 임상상" 48 : 618-624, 1995

5 "국립보건원 주요전염병 통계" 2003

6 "국내 풍토병에 대한 백신" 20 : 249-57, 1992

7 "경기 북부지역에서 발생한 렙토스피라병 15예에 대한 임상적 관찰" 32 : 76-84, 1987

8 "Weil's disease associated with pancreatic necrosis" 2 : 93-5, 1959

9 "The Role of Glucocorticoid Pulse Therapy in Pulmonary Involvement in Leptospirosis" 49 : 901-903, 2001

10 "Surgical complications of leptospirosis in children" 13 : 325-30, 1978

11 "Studies on Anicteric Leptospirosis:Clinical Manifestations and Antibiotic Therapy" 84 : 283-91, 1965

12 "Serum Creatinine Phosphokinase in Leptospirosis" 233 : 981-, 1975

13 "Painless Pancreatitis:A rare manifestation of Leptospirosis" 50 : 1318-1319, 2002

14 "Leptospirosis with acute acaculous cholecystitis and pancreatitis" 16 : 52-4, 1993

15 "Leptospirosis in Latin America" 14 : 23-39, 2000

16 "Leptospirosis in Chonbuk Province of Korea in 1987:a Study of 93 Patients" 41 : 345-51, 1989

17 "Lepospirosis Presenting as Diffuse Alveolar Hemorrhage:Case Report and Literature Review" 123 : 639-643, 2003

18 "Hyperamylasemia and pancreatitis in leptospirosis" 86 : 1665-8, 1991

19 "Human Leptospirosis in the Seychelles(Indian Ocean)a Population Study" 59 : 933-940, 1998

20 "Evaluation of Four Commercial Available Rapid Serologic Tests for Diagnosis of Leptospirois" 41 : 803-809, 2003

21 "Ceftriaxone Compared with Sodium Penicillin G for Treatment of Severe Leptospirosis" 36 : 1507-1513, 2003

22 "Assessment of the Clinical Presentation and Treatment of 353 Cases of Laboratory- confirmed Leptospirosis in Hawaii,1974-1998" 33 : 1834-1841, 2001