Top

Journal of Medical Case Reports

Published in:

Open Access 01-12-2013 | Case report

Plasma exchange in severe leptospirosis with multi-organ failure: a case report

Authors: Dominic Taylor, Lazarus Karamadoukis

Published in: Journal of Medical Case Reports | Issue 1/2013

Abstract

Introduction

Leptospirosis presents with disease of variable severity; multi-organ failure can occur. In this situation, plasma exchange has been used with positive results, although the mechanism of action has not been fully explained.

Case presentation

A 67-year-old Caucasian man developed severe leptospirosis with marked icterus, acute kidney injury and cardiorespiratory failure, after exposure to livestock. On the basis of previous reported cases, he was treated with plasma exchange. This led to a rapid improvement in his bilirubin level, cardiac and respiratory function, followed by renal function.

Conclusion

We discuss the pathophysiology of the disease, and suggest that plasma exchange has a role in the treatment of severe sepsis caused by leptospirosis as well as immune complex-mediated organ injury.

Available only for authorised users

Levett PN: Leptospirosis. Clin Microbiol Rev. 2001, 14 (2): 296-10.1128/CMR.14.2.296-326.2001.CrossRefPubMedPubMedCentral

World Health Organisation: http://www.who.int/zoonoses/diseases/leptospirosis/en/ accessed December 2011

Fraga TR, Barbosa AS, Isaac L: Leptospirosis: aspects of innate immunity, immunopathogenesis and immune evasion from the complement system. Scand J Immunol. 2010, 73: 408-419.CrossRef

Watt G, Padre LP, Tuazon ML, Calubaquib C, Santiago E, Ranoa CP, Laughlin LW: Placebo-controlled trial of intravenous penicillin for severe and late leptospirosis. Lancet. 1988, 1 (8583): 433-CrossRefPubMed

Kularatne SA, Budagoda BD, de Alwis VK, Wickramasinghe WM, Bandara JM, Pathirage LP, Gamlath GR, Wijethunga TJ, Jayalath WA, Jayasinghe C, Pinto V, Somaratne P, Kumarasiri PV: High efficacy of bolus methylprednisolone in severe leptospirosis: a descriptive study in Sri Lanka. Postgrad Med J. 2011, 87: 13-17. 10.1136/pgmj.2009.092734.CrossRefPubMed

Trivedi SV, Vasava AH, Bhatia LC, Patel TC, Patel NK, Patel NT: Plasma exchange with immunosuppression in pulmonary alveolar haemorrhage due to leptospirosis. Indian J Med Res. 2010, 131: 429-433.PubMed

Tse KC, Yip PS, Hui KM, Li FK, Yuen KY, Lai KN, Chan TM: Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure. Clin Vaccine Immunol. 2002, 9 (2): 482-484. 10.1128/CDLI.9.2.482-484.2002.CrossRef

Cerdas-Quesada C: Potential benefits of plasma exchange by apheresis on the treatment of severe Icteric Leptospirosis: Case report and literature review. Transfus Apher Sci. 2011, 45 (2): 191-194. 10.1016/j.transci.2011.07.012.CrossRefPubMed

Yang C-W, Wu M-S, Pan M-J: Leptospirosis renal disease. Nephrol Dial Transplant. 2001, 16 (Suppl. 5): 73-77.CrossRefPubMed

10.

Werts C: Leptospirosis: a Toll road from B lymphocytes. Chang Gung Med J. 2010, 33 (6): 591-601.PubMed

11.

van Deuren M, Frieling JTM, van der Ven-Jongekrijg J, Neeleman C, Russel FGM, van Lier HJJ, Bartelink AKM, van der Meer JWM: Plasma patterns of Tumour Necrosis Factor-α (TNF) and TNF soluble receptors during acute meningococcal infections and the effect of plasma exchange. Clin Infect Dis. 1998, 26: 918-923. 10.1086/513933.CrossRefPubMed

12.

Szczepiorkowski ZM, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Shaz BH, Weinstein R, Wirk A, Winters J: Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the apheresis applications committee of the American Society for Apheresis. J Clin Apher. 2007, 22: 106-175. 10.1002/jca.20129.CrossRefPubMed

13.

Medeiros FR, Spichler A, Athanazie DA: Leptospirosis-associated disturbances of blood vessels, lungs and hemostasis. Acta Trop. 2010, 115: 155-162. 10.1016/j.actatropica.2010.02.016.CrossRef

14.

Galli M, Esposito R, Crocchiolo P, Chermotti M, Gasparro P, Dall’Agio P: Immune complexes in leptospirosis. Infection. 1985, 13: 156-10.1007/BF01642877.CrossRefPubMed

15.

Pawar RD, Patole PS, Zecher D, Segerer S, Kretzler M, Schlöndorff D, Anders HJ: Toll-like receptor-7 modulates immune complex glomerulonephritis. J Am Soc Nephrol. 2006, 17: 141-149. 10.1681/ASN.2005121335.CrossRefPubMed

Title: Plasma exchange in severe leptospirosis with multi-organ failure: a case report
Authors: Dominic Taylor
Lazarus Karamadoukis
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: Journal of Medical Case Reports / Issue 1/2013
Electronic ISSN: 1752-1947
DOI: https://doi.org/10.1186/1752-1947-7-169

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Plasma exchange in severe leptospirosis with multi-organ failure: a case report

Abstract

Introduction

Case presentation

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Case presentation

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2013

Pseudotumoral tuberculous ureteritis: a case report

Molecular analysis of appendiceal mucinous cystadenoma and rectal adenocarcinoma in a patient with urothelial carcinoma: a case report

Aphonia induced by simultaneous bilateral ischemic infarctions of the putamen nuclei: a case report and review of the literature

Improvement of pneumatosis cystoides intestinalis after steroid tapering in a patient with bronchial asthma: a case report

Granulomatosis with polyangiitis presenting as an orbital inflammatory pseudotumor: a case report

Catfish spine envenomation and bacterial abscess with Proteus and Morganella: a case report