Abstract
BackgroundLeptospirosis is a common zoonotic infection caused by the spirochete Leptospira. The disease is more prevalent in the tropics, causing subclinical to severe illness leading to high morbidity and mortality.Case presentationA 77-year-old healthy Sri Lankan man presented to the Teaching Hospital Peradeniya with severe leptospirosis complicated with acute kidney injury, pulmonary hemorrhages, myocarditis, and severe thrombocytopenia. He was deteriorating despite treatment with intravenous antibiotics and methylprednisolone boluses. He made a dramatic improvement with two cycles of plasma exchange.ConclusionTherapeutic plasma exchange is a life-saving treatment modality in severe leptospirosis with multiorgan failure.
Highlights
IntroductionThe patients’ complete blood count showed white blood cells (WBCs) of 4.46 × 109/L (neutrophils 82%, lymphocytes 16%), platelet count 42 × 109/L, hemoglobin (Hb) 13 g/dL, and hematocrit (HCT) of 37%
Intravenous methylprednisolone is used to treat severe leptospirosis based on the immune-mediated pathogenesis of the disease, and it has been shown to be beneficial to reduce mortality [8]
A study of 53 patients with serologically confirmed complicated leptospirosis demonstrated a mortality rate of 36.4% in the therapeutic plasma exchange (TPE) only group, 21.4% in the intravenous immunoglobulin and therapeutic plasma exchange group, and 92.8% in the group that was given neither of these two therapies
Summary
The patients’ complete blood count showed white blood cells (WBCs) of 4.46 × 109/L (neutrophils 82%, lymphocytes 16%), platelet count 42 × 109/L, hemoglobin (Hb) 13 g/dL, and hematocrit (HCT) of 37% His C-reactive protein was 345 mg/L, and creatinine was 359 μmol/L. The patient was started on intravenous showed widespread T inversions, and the 2D echocardiogram showed ejection fraction (EF) of 30% with left ventricular global hypokinesia. His procalcitonin level was 37.94 ng/mL, and the platelet count was 54 × 109/L. The patient was started on plasma exchange on the fourth day of admission, and 1840 mL plasma was removed along with transfusion of 1100 mL fresh frozen plasma and 1000 mL normal saline. In follow-up, the patient was reviewed after 2 weeks and found to be in good health
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