A 16-year-old man with leptospirosis and atypical disseminated intravascular coagulation: a case report

Abstract

Background: Leptospirosis is known for its pulmonary form characterized by intra-alveolar hemorrhage, exhibiting a high mortality rate. Management by venous-venous extracorporeal membrane oxygenation has been reported in a small number of cases.

Case presentation: We report herein the case of a 16-year-old Caucasian male who was admitted with rapidly deteriorating respiratory and digestive complaints. He developed severe acute respiratory distress syndrome secondary to disseminated intravascular coagulation and intra-alveolar hemorrhage, requiring initiation of venous-venous extracorporeal membrane oxygenation. Initial infectious and immunological assessments were inconclusive, but repeat serology on the tenth day of admission confirmed a diagnosis of leptospirosis. The patient received multiple transfusions, and upon favorable response to treatment with corticosteroids and antibiotics, he was successfully weaned off venous-venous extracorporeal membrane oxygenation, which was discontinued after 12 days.

Conclusion: Leptospirosis is a rare cause of severe acute respiratory failure following pulmonary hemorrhage. It is typically diagnosed by serology, with detectable IgM antibodies 5-7 days after the onset of symptoms. We report that early support with respiratory extracorporeal membrane oxygenation favors timely clearance of endobronchial clotting, parenchymal recovery, and prevention of ventilator-induced lung injury. Major hypofibrinogenemia, which did not seem to worsen during extracorporeal membrane oxygenation application, was managed by repeated transfusions. Further studies investigating the pathogenesis of this coagulopathy are required to further optimize the management of this rare and severe complication.

Keywords: Case report; Diffuse alveolar hemorrhage; Extracorporeal life support; Leptospirosis; Multiple organ failure.

Fig. 1

Chest radiography on arrival at the emergency room (H0): bilateral alveolar interstitial syndrome

Fig. 2

Chest scan on admission to intensive care (H + 6): diffuse alveolar syndrome with 80% lung damage

Fig. 3

Chest scan on admission to intensive care (H + 6): diffuse alveolar syndrome with 80% lung damage

Fig. 4

Chest scan 10 hours after admission to intensive care (H + 16): clear increase of pulmonary intraparenchymal lesions with complete involvement of both lungs

Fig. 5

Chest scan 10 hours after admission to intensive care (H + 16): clear increase of pulmonary intraparenchymal lesions with complete involvement of both lungs