Abstract
Background: Leptospirosis is a zoonotic disease with high prevalence in Sri Lanka predominantly in paddy cultivating areas. Severe leptospirosis is rarely described in pregnancy and there is a scarcity of data regarding its effect on pregnant patients. Acute lung injury has been recognized as the commonest fatal complication of leptospirosis. We report a case of delayed presentation of fulminant leptospirosis in a pregnant patient complicated with acute respiratory distress syndrome (ARDS) and severe coagulopathy resulting in death despite the optimum medical care.Case Presentation: A-31-year-old woman in the twelfth-week of pregnancy admitted with a subacute history of frequent vomiting, dry cough, watery stools, vaginal spotting, hemoptysis, and progressive shortness of breath. She had tachycardia, hypotension, and acute severe respiratory distress with high-grade fever on admission. Her inflammatory markers were high with evidence of severe coagulopathy. With worsening clinical and biochemical parameters despite intensive medical intervention, patient had a fatal outcome. The autopsy revealed shock lung with multiple intra-alveolar hemorrhages. The serum Leptospira microscopic agglutination test (MAT) was positive confirming the fulminant leptospirosis.Conclusion: Prolongrespiratory symptoms; positive lung signs with acute respiratory distress can mimic the clinical picture of atypical pneumonia. Delayed presentation of ARDS limits the management options whilst increasing the risk of fatality. A high degree of suspicion is needed to diagnose leptospirosis in pregnancy.
Highlights
Leptospirosis is a re-emerging zoonotic disease in Sri Lanka.[1]
Delayed presentation of acute respiratory distress syndrome (ARDS) in leptospirosis limits the management options and increases the complexity of scenario when it is complicating with severe thrombo-hemorrhagic syndromes
We report a case of delayed presentation of fulminant leptospirosis in the first trimester of pregnancy complicated with acute respiratory distress syndrome and severe coagulopathy ended up with inevitable death despite the optimum medical care
Summary
Leptospirosis is a re-emerging zoonotic disease in Sri Lanka.[1]. Severe leptospirosis is rarely described in pregnancy[2,3] and there is a scarcity of data regarding its effect on the pregnant patients.3Acute lung injury has been recognized as the commonest fatal complication of leptospirosis in certain studies.4Severe leptospirosis in pregnancy may be confused with hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and acute fatty liver of pregnancy. Delayed presentation of ARDS in leptospirosis limits the management options and increases the complexity of scenario when it is complicating with severe thrombo-hemorrhagic syndromes. This causes rapid deterioration and unfavorable fatal outcomes. We report a case of delayed presentation of fulminant leptospirosis in the first trimester of pregnancy complicated with acute respiratory distress syndrome and severe coagulopathy ended up with inevitable death despite the optimum medical care. Intravenous sedation, central venous pressure monitoring, restriction of fluid infusion, and continuation of intravenous antibiotics were given with maximum supportive care She developed bleeding from the endotracheal tube and blood pressure dropped to 80/50mmHg subsequently. The serum Leptospira microscopic agglutination test (MAT) was reported as positive (>1/400)
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