An 18-year-old man presented with a 2-day history of fever, vomiting, and diarrhea. Three weeks before presentation, he had fallen into a canal. Physical exam was notable for the findings shown in the image. Laboratory studies showed acute kidney injury and elevations in aminotransferase and total bilirubin levels. What is the most likely diagnosis?患者男，18岁，因发热、呕吐、腹泻 2d 就诊。就诊前3周曾坠入运河。体格检查显示图像中的结果明显。实验室研究显示急性肾损伤以及转氨酶和总胆红素水平升高。最可能的诊断是什么？
A. Acute hemorrhagic conjunctivitis
B. Ebola hemorrhagic fever
C. Giardiasis
D. Leptospirosis
E. Subarachnoid hemorrhage
答案解析：
根据患者的典型表现（包括结膜下出血）和暴露于可能被啮齿类动物尿液污染的水，怀疑钩端螺旋体病表现为发热、黄疸、肾衰竭和出血。开始静脉注射青霉素经验性治疗。血清核酸扩增试验鉴定出出血性黄疸型血清群的钩端螺旋体种属。3周后随访，其症状、结膜下出血和肝肾损伤已消退。
正确答案：D
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