Leptospirosis with pulmonary haemorrhage and multiple organ failure: a case report and literature review

Abstract

Pulmonary haemorrhage is an important complication of leptospirosis. We herein report an uncommon case of severe pulmonary haemorrhage and multiple organ failure caused by leptospirosis in a 49-year-old man who was previously healthy. He was a farm worker who was admitted to the hospital because of haemoptysis. He had worked in a paddy field 4 days prior to admission. Chest computed tomography revealed pulmonary haemorrhage, which rapidly deteriorated into haemorrhagic shock and multiple organ failure. Based on the patient’s possible history of contact with contaminated water and the DNA sequence of Leptospira detected in his bronchoalveolar lavage fluid, the patient was diagnosed with pulmonary haemorrhagic leptospirosis. Despite the administration of a fluid bolus, norepinephrine, broad-spectrum antibiotics, and haemostatics, and even with administration of a blood transfusion and extracorporeal life support, the pulmonary haemorrhage could not be controlled effectively. The patient eventually died of haemorrhagic shock. Leptospirosis can be a life-threatening disease despite aggressive treatment, even with extracorporeal life support. Next-generation sequencing can provide important diagnostic clues for patients with atypical leptospirotic symptoms.

Pulmonary haemorrhage as the earliest sign of severe leptospirosis in hamster model challenged with Leptospira interrogans strain HP358

“…As observed in the present study, the lungs were the first organ showing damage, hence it is important to monitor the respiratory problems or bleeding in leptospirosis patients as a prognostic factor for severe leptospirosis. As reported in previous studies, pulmonary haemorrhage could occur prior to jaundice and renal failure and led to severe disease and fatality in human leptospirosis [ 34 , 35 ].…”

Clinical characteristics and prognosis of patient with leptospirosis: A multicenter retrospective analysis in south of China

“…Leptospira interrogans serogroup Icterohaemorrh agiae serovar Lai ( Hu et al., 2014 ) was the most common pathogen in Chinese leptospirosis patients, which was also the causative pathogen in 75% of the pulmonary diffuse hemorrhagic leptospirosis. The 15.8% mortality rate was slightly higher than the mean case fatality ratio of 6.85% ( Costa et al., 2015 ), and the majority of leptospirosis deaths was due to renal failure and/or gastrointestinal, pulmonary, or cerebral hemorrhage ( Vijayachari et al., 2008 ; Dong and Chen, 2021 ) caused by extensive capillary damage including extensive renal necrosis and glomerular atrophy. Moreover, leptospira increased the permeability and engorgement of blood vascular cells ( Narayanavari et al., 2015 ; Matsunaga and Haake, 2018 ; Zavala-Alvarado et al., 2020 ).…”

Next Generation Sequencing for Diagnosis of Leptospirosis Combined With Multiple Organ Failure: A Case Report and Literature Review

“…Most deaths from leptospirosis are attributed to renal failure and/or gastrointestinal, pulmonary, or cerebral hemorrhage ( 24 – 26 ) caused by extensive capillary damage including extensive renal necrosis and glomerular atrophy. Some bacterial pathogens produce hemolysins including Sph2, and the expression of Sph2 is highest among epithelial cells ( 27 ).…”