Leptospirosis complicated with Guillain Barre syndrome, papillitis and thrombotic thrombocytopenic Purpura; a case report

Abstract

BackgroundLeptospirosis is a zoonosis commonly prevalent in tropical countries. Clinical course of leptospirosis varies from mild to severe disease. Here we present a case of leptospirosis complicated with Guillain-Barre Syndrome (GBS), papillitis, and Thrombotic Thrombocytopenic Purpura(TTP).Case presentationA 21-year-old Asian male presented with fever, myalgia, oliguria and dyspnoea where he was managed as for leptospirosis complicated with pulmonary haemorrhages and acute renal failure. Leptospirosis was confirmed by Microscopic Agglutination Test(MAT) with a fourfold rise in antibody titre between acute and convalescent serum. The highest antibody titre was against Leptospira antigen serogroup Semaranga (strain Patoc) (1:1280) followed by serogroup Australis (strain Australis) (1:640) and serogroup Autumnalis (strain Bankgkinang) (1:320). Two weeks later he developed blindness, ascending weakness of lower limbs with global areflexia and an acute inflammatory demyelinating polyradiculopathy(AIDP) variant GBS was confirmed with nerve conduction studies. TTP complicated the picture several days later. He was initiated on plasmapheresis where clinical improvement was seen after 14 cycles. He had an incomplete neurological recovery with permanent vision loss but completely recovered from TTP. He also had permanent renal impairment.ConclusionLeptospirosis should be suspected and treated empirically in the relevant clinical settings where it can present with an atypical clinical picture as in our case with an acute febrile illness followed by GBS as well as TTP.

Concurrent thrombotic thrombocytopenic purpura and Guillian Barre Syndrome post infectious diarrhea

“…GBS has also been reported with posterior reversible encephalopathy syndrome (PRES), Covid-19 infections, myasthenia gravis, nephrotic syndrome, pulmonary tuberculosis to name a few [ [21] , [22] , [23] , [24] , [25] ]. However, as per our review we found only one case reporting “leptospirosis complicated by sequential GBS, papillitis and TTP [ 26 ]. We are reporting the second case but the first one concurrently affected by GBS and TTP.…”

“…Campylobacter has been reported with TTP and GBS both [ 16 , 17 , [26] , [27] ]. Occurrence of GBS is sometimes 77 times higher in those who had Campylobacter infection compared to the general population [ 28 ].…”

Fulminant Guillain–Barré Syndrome and Spontaneous Intraventricular Hemorrhage: A Case Report and Literature Review

“…The pathogenic mechanism has been discussed for more than a century. The disease can be induced by a number of microorganisms, including Campylobacter jejuni , cytomegalovirus, leptospirosis, Epstein–Barr virus, Hepatitis E virus, and Zika virus ( Creange, 2016 ; Willison et al, 2016 ; Kobawaka Gamage and Fernando, 2018 ). Molecular mimicry of gangliosides caused by these pathogenic microorganisms may take part in the occurrence and development of GBS ( Goodfellow and Willison, 2016 ; Willison et al, 2016 ).…”

Diplejía facial como manifestación de neuroleptospirosis

“…Varios tipos de infecciones han sido asociadas al SGB, principalmente de tipo respiratorio y gastrointestinal en 70% de los casos. La asociación con leptospirosis una de las zoonosis de mayor distribución mundial generada por la espiroqueta del orden Spirochaetales, de la familia Leptospiraceae, del género Leptospira se ha documentado con menor frecuencia (4)(5)(6)(7). Esta infección en la mayoría de los casos tiene una presentación clínica bifásica que co-mienza con un fase septicémica, seguida de manifestaciones inmunes con un espectro clínico amplio que va desde un síndrome febril con síntomas constitucionales leves hasta un cuadro severo acompañado de falla multiorgánica (8).…”