Pediatric Fulminant Leptospirosis Complicated by Pericardial Tamponade, Macrophage Activation Syndrome and Sclerosing Cholangitis

Abstract

Background: Leptospirosis is a zoonotic infectious disease caused by pathogenic spirochetes of the genus Leptospira. Although it is usually asymptomatic and self-limited, severe potentially fatal illness accompanied by multi-organ failure may occur. Case Report: Here we report an unusual case of severe leptospirosis successfully treated with continuous venovenous hemofiltration (CVVHF) and therapeutic plasma exchange (TPE). The patient presented with pericardial tamponade, renal failure and macrophage activation syndrome, and later suffered prolonged jaundice and sclerosing cholangitis during hospitalization in the pediatric intensive care unit (PICU). To the best of our knowledge, sclerosing cholangitis due to leptospirosis has not been reported in the literature. Conclusion: Leptospirosis should be kept in mind in the differential diagnosis of sepsis and septic shock with fever, thrombocytopenia, jaundice and renal failure. TPE and CVVHF should start early after the diagnosis of leptospirosis with multiorgan failure

Keywords

• Leptospirosis, macrophage activation syndrome, pericardial tamponade, sclerosing cholangitis

References

1. 1. American Academy of Pediatrics: Leptospirosis. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red Book:2012 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2012:469-71.
2. 2. Abdulkader RC, Silva MV. The kidney in leptospirosis. Pediatr Nephrol 2008;23:2111-20. [CrossRef]
3. 3. Anisimova IuI, Matiash VI. The pathomorphology and pathogenetic problems of liver involvement in icterohemorrhagic leptospirosis. Lik Sprava 1999;4:111-16.
4. 4. Edwards CN, Nicholson GD, Hassell TA, Everard CO, Callender J. Leptospirosis in Barbados. A clinical study. West Indian Med J 1990;39:27-34.
5. 5. Krishnamurthy S, Mahadevan S, Mandal J, Basu D. Leptospirosis in association with hemophagocytic syndrome: a rare presentation. Indian J Pediatr 2013;80:524-5. [CrossRef]
6. 6. Yang CW, Pan MJ, Wu MS, Chen YM, Tsen YT, Lin CL, et al. Leptospirosis: an ignored cause of acute renal failure in Taiwan. Am J Kidney Dis 1997;30:840-5. [CrossRef]
7. 7. Sripanidkulchai R, Lumbiganon P. Etiology of obscure fever in children at a university hospital in northeast Thailand. Southeast Asian J Trop Med Public Health 2005;36:1243-6.
8. 8. Daher EF, Silva GB, Silveira CO, Falcao FS, Alves MP, Mota JA, et al. Factors associated with thrombocytopenia in severe leptospirosis (Weil’s disease). Clinics (Sao Paulo) 2014;69:106-10. [CrossRef]

9. 9. Nguyen TC, Carcillo JA. Bench-to-bedside review: thrombocytopenia-associated multiple organ failure - a newly appreciated syndrome in the critically ill. Crit Care 2006;10:235. [CrossRef]
10. 10. Sevketoglu E, Yildizdas D, Horoz OO, Kihtir HS, Kendirli T, Bayraktar S, et al. Use of therapeutic plasma exchange in children with thrombocytopenia-associated multiple organ failure in the Turkish thrombocytopenia-associated multiple organ failure network. Pediatr Crit Care Med 2014;15:354-9. [CrossRef]