Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis

Abstract

Background Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. Case presentation The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient’s condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. Conclusions Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO.

Severe Jarisch-Herxheimer Reaction (JHR) in a leptospirosis patient: A case report

“…Through literature search, we realized that antibiotics related to the development of JHR not only include penicillins, tetracyclines and erythromycin, but also newer antimicrobial agents such as cephalosporins, levofloxacin, ciprofloxacin, clarithromycin, meropenem, and azithromycin can also cause JHR [ 1 ]. To prove the relationship between leptospirosis and JHR and predict the characteristics of patients with severe types, we searched and reviewed the presentation of five adults with pulmonary hemorrhagic leptospirosis, and found that they all showed aggravation of existing symptoms or the occurrence of new symptoms that cannot be explained by the progression of the disease [ [2] , [3] , [4] , [5] , [6] ]. However, they survived after active symptomatic treatment ( Table 2 ).…”

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

“…It can detect Leptospira DNA in specimens quickly and accurately during the early stage of the infection. 21,22 Fifteen other reports [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] have described different diagnostic methods for severe leptospirosis requiring extracorporeal membrane oxygenation. As shown in Table 2, PCR, the MAT, ELISA, and NGS can be used to diagnose severe leptospirosis early.…”

Pica (Allotriophagy): An Underestimated Risk Factor for Severe Leptospirosis (Weil’s Diseases)? Report of a Leptospira Septic Shock Successfully Managed with ECMO

“…ECMO support in severe leptospirosis was previously described as an effective treatment for reducing patient mortality. Twelve recent case reports describe the use of a V-V ECMO in patients with leptospirosis complicated by ARDS and hemorrhagic pneumonia; only one patient died [ 6 , 18 , 19 , 20 ]. Two case reports described the use of V-A ECMO in two patients affected by complicated leptospirosis with (1) right ventricular overload and myocarditis and (2) cardiogenic shock and pulseless electrical activity, respectively.…”