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📋🩺 'Successful utilization of plasma exchange and corticosteroids in the management of thrombotic microangiopathy and acute respiratory distress syndrome secondary to leptospirosis-a case report' - published in the European Journal of Medical #CaseReports (EJMCR) on #ScienceOpen:
🔗 Discover STM Publishing Ltd, Ireland: https://www.scienceopen.com/hosted-document?doi=10.24911/ejmcr.173-1724599359
#Leptospirosis #InfectiousDiseases #CriticalCare #PlasmaExchange #TropicalMedicine
Successful utilization of plasma exchange and corticosteroids in the management of thrombotic microangiopathy and acute respiratory distress syndrome secondary to leptospirosis-a case report
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<h5 class="section-title" id="d2863344e182">Background:</h5>
<p dir="auto" id="d2863344e184">Leptospirosis, a zoonotic infection caused by
<i>Leptospira</i> bacteria, presents with symptoms ranging from mild flu-like signs to severe multiorgan
failure. A rare but serious complication of leptospirosis is thrombotic microangiopathy
(TMA). This case report discusses the treatment of a 52-year-old female with leptospirosis
complicated by TMA, highlighting the effectiveness of plasma exchange and corticosteroids
in her recovery.
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<h5 class="section-title" id="d2863344e190">Case Presentation:</h5>
<p dir="auto" id="d2863344e192">A 52-year-old female presented with a five-day history of fever and progressive shortness
of breath. Upon admission, she had tachypnoea, a partial pressure of oxygen in arterial
blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) ratio of 61,
and bilateral lung infiltrates, requiring invasive mechanical ventilation and prone
positioning. Laboratory tests revealed anemia, thrombocytopenia, schistocytes, and
elevated lactate dehydrogenase, suggesting TMA. The patient also showed elevated liver
enzymes and signs of a potential diagnosis of thrombotic thrombocytopenic purpura,
though serological tests for tropical infections, including leptospirosis, were initially
negative. The patient was treated with plasma exchange and corticosteroids, leading
to improvements in her hematological parameters and acute respiratory distress syndrome
(ARDS). However, she developed unexplained blood pressure and heart rate fluctuations,
and electroencephalogram confirmed focal seizures, which were treated with levetiracetam
and propofol. Subsequent serological testing confirmed leptospirosis with positive
Immunoglobulin M antibodies and Leptospira polymerase chain reaction testing. The
patient was treated with doxycycline and ceftriaxone, resulting in significant improvement,
successful extubation, and eventual discharge.
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<h5 class="section-title" id="d2863344e195">Conclusion:</h5>
<p dir="auto" id="d2863344e197">This case highlights the challenges of managing leptospirosis complicated by TMA and
severe ARDS. Plasma exchange and corticosteroids were essential in the patient’s recovery.
The initial delay in diagnosis due to negative serological tests underscores the importance
of maintaining a high index of suspicion for leptospirosis in severe tropical illness
cases with TMA. The patient’s positive response to treatment, including resolution
of seizures and hemodynamic instability, demonstrates the value of prompt and targeted
interventions. The case emphasizes the need for a multidisciplinary approach in managing
complex leptospirosis cases with severe complications.
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