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Home Toxycology QUIZ: A sewage plant worker *solved*

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QUIZ: A sewage plant worker *solved* PDF Print E-mail
Author: toxman
User Rating: / 2
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Wednesday, 28 October 2009 20:28

Case description: An ambulance was called to 25 years old sewage plant worker. His wife was anxious about her husband?s bad state. Interview: 2 weeks ago patient had pseudoinfluenza symptoms(myalgia, arthralgia, chills, fever). For about a week his skin has had yellow tint. He also complains about constant pain in kidney area and nosebleed that started yesterday. He also developed ecchymoses visible in abdominal skin.

 
 

Comments  

 
0 #1 G.J. 2009-10-28 20:42
Ad.1. AspaT AlaT, LDH, bilirubin, electrolytes, APTT urine test (creatinine, uric acid, urea, urobilinogen), abdominal ultrasound

Ad.2. I consider hep B or C, or liver failure after exposure to the chemical compounds.
 
 
0 #2 toxman 2009-10-28 20:47
Tests revealed icterus with high level of hepatic enzymes, hyperkalemia. Urea i creatinine are significantly elevated. The urine test discovered the presence red and white blood cells and squamous cells. Ultrasound revealed heterogenous structure of the spleen and the liver.
Tests for hep B, C are negative.
 
 
0 #3 opentany 2009-10-28 21:57
What was the state of lymph nodes in USG? Was he taking any antibiotics recently?
 
 
0 #4 G.J. 2009-10-28 21:57
I would start with blood test, CRP, maybe ASO and Shiga toxin test(I'm thinking about hemolytic-uremic syndrome)
 
 
0 #5 toxman 2009-10-28 22:08
abdominal lymphnodes are enlarged.

blood test showed granulocytosis,
ASO negative, Shigell/Salmonella infection excluded.

Hemolytic-uremic syndrome for 100% compared with hepatopathy equals...?
 
 
0 #6 G.J. 2009-10-28 22:49
The presence of granulocytes may indicate bacteria as a cause of the symptoms, maybe an EHEC strain infection(Esche richia coli O157H7)?
 
 
0 #7 toxman 2009-10-28 22:57
But can EHEC strain cause both kidney and liver failure? Of course patient bleeds, but from his nose and to the skin, not from the anus. Anyway bacterial track is the right track:-)
 
 
0 #8 kisia 2009-10-28 23:03
Weil's syndrome?
 
 
0 #9 toxman 2009-10-28 23:08
What makes you think about Weil's syndrome?
 
 
0 #10 kisia 2009-10-28 23:11
occupation - a sewage plant is a perfect habitat for leptospirosis, kidney and liver failure.
 
 
0 #11 toxman 2009-10-29 12:09
Solution: Weil's syndrome

Kisia - you combined 3 basic elements - interview(sewag e plant, pool, water basin) + nephropathy + hepatopathy

Congratulations !
 
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