Leptospirosis: A Rare Cause of ARDS

Abstract

SESSION TITLE: Critical Care 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Leptospirosis is a spirochetal infection, which can manifest as a mild flu-like illness or as a life threatening multi-system organ dysfunction. We report a case of Leptospirosis presenting with multiple system organ dysfunction including ARDS. CASE PRESENTATION: A 55-year-old man presented to the Emergency Department with a 3-day history of severe muscle cramps in both legs, generalized aches, fevers, chills, and a productive cough with blood-tinged sputum. He reported a recent trip to Jamaica, where he lacerated his foot. Initial vital signs: HR 98, BP 121/79, Temp 36°C, RR 16, SpO2 98% on room air. Physical exam revealed tenderness in the RUQ of his abdomen and his lower extremities. Chest XR revealed bibasilar reticulonodular opacities. Laboratory studies showed a WBC of 13,000 with a neutrophil predominance, platelet count 75,000, hemoglobin 12.6, creatinine of 2.4, creatine phosphokinase 3353. His differential diagnosis included infection with: Hantavirus, Zika virus, Dengue, Leptospira, and Legionella. He was started empirically on azithromycin and doxycycline. His course was complicated by hypoxic respiratory failure with worsening bilateral infiltrates and a P/F ratio of 177 with an ejection fraction >50% by TTE. Other organ dysfunction also worsened: creatinine 3.6; platelet count 25,000, and total bilirubin 13.3. Hepatobiliary imaging showed multiple liver cysts without evidence of biliary obstruction. He ultimately tested positive for leptospira DNA. He was managed conservatively with respiratory support, IV fluids and doxycycline. He gradually improved and was discharged home. DISCUSSION: Leptospirosis is a rare cause of ARDS and typically presents with mild illnesses. An outbreak in the United States consisted of mild disease, presenting with fevers and myalgias (1), but more severe cases of leptopirosis have presented with acute renal failure, conjugated hyperbilirubinemia, and pulmonary infiltrates without requirement of supplemental oxygen (2). To our knowledge, this is the first reported case of ARDS in the United States secondary to leptospirosis. CONCLUSIONS: Leptospirosis in rare instances can present with ARDS. History of travel to endemic areas should prompt consideration of this as a possible etiology. While leptospirosis can have a complicated course, timely administration of appropriate antibiotics can improve outcome. Reference #1: Update: Leptospirosis and Unexplained Acute Febrile Illness Among Athletes Participating in Triathlons - Illinois and Wisconsin, 1998. (1998, August 28). https://www.cdc.gov/mmwr/preview/mmwrhtml/00054395.htm Reference #2: Pothuri, P., Ahuja, K., Kumar, V., Lal, S., Tumarinson, T., & Mahmood, K. (2016). Leptospirosis Presenting with Rapidly Progressing Acute Renal Failure and Conjugated Hyperbilirubinemia: A Case Report. American Journal of Case Reports, 17, 567-569. doi:10.12659/ajcr.897741 DISCLOSURE: The following authors have nothing to disclose: Martin Senese, Shaeesta Khan, Michael Murray No Product/Research Disclosure Information