A Leptospirosis Case Presenting with Thrombotic Thrombocytopenic Purpura

Year 2013, , 436 - 438, 01.04.2013

Köse Şükran Bengü Tatar Gürsel Ersan Selim Topaloğlu

https://doi.org/10.5152/balkanmedj.2013.9078

Abstract

A Leptospirosis Case Presenting with Thrombotic Thrombocytopenic Purpura

Abstract

Background: Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasion­ally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported. Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis. Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions. Turkish Başlık:Trombotik Trombositopenik Purpurayla Seyreden Bir Leptospiroz Olgusu Anahtar Kelimeler:Leptospiroz, Weil hastalığı, trombotik trombositopenik purpura Arkaplan: Leptospiroz, leptospira cinsi spiral mikroorganizmalar tarafından oluşturulan bir zoonozdur. Leptospiroz sıklıkla tropikal bölgelerde görülmesine rağmen, gelişmekte olan ülkelerde ılıman bölgelerde de rastlanabilmektedir. Hastalık asemptomatik enfeksiyondan ciddi, ölümcül seyredebilen çoklu organ yetmezliğine kadar geniş klinik yelpaze görülür. Bununla birlikte atipik başvuru nadiren görülmektedir Olgu Sunumu: Elli sekiz yaşında erkek olgu ateş yüksekliği, idrar renginde koyulaşma ve görsel halüsinasyonla başvurdu. Laboratuvar incelemesinde anemi, ciddi trombositopeni,indirek hakimiyeti olan bilirubin yüksekliği, yüksek laktat dehidrogenaz, yüksek üre (293 mg/dL) ve kreatinin (7.6 mg/dL) düzeyleri mevcuttu. TTP tanısı aldı. Atipik klinik şekilli leptospiroz düşünüldü. Leptospirozis tanısı yüksek pozitif mikroskopik aglütinasyon testi ile doğrulandı. Hasta antibiyotik tedavisi ve plazmaferezle tamamen iyileşti. Sonuç: Özellikle subtropik bölgelerde, leptospiroz trombotik trombositopenik purpurayla birliktelik gösterebilir.

Keywords

Leptospirosis, Weil’s disease, thrombotic thrombocytopenic purpura

References

• Levett PN, Haake DA. Leptospirosis. In Mandell GL, Bennett JE, Dolin R, editors. Infectious Diseases. Philadelphia: Churchill Livingstone Elsevier Press. 2010;3059-3065. Acha, PN, Szyfres B. Leptospirosis. In 3rd Pan American Health Organization, edition. Zoonoses and Communicable Disease Common to Man and Animals, Washington: PAHO Press. 2001;157.