Case Reports
Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature
Authors:
U. Tharanga ,
De Soysa Teaching Hospital for Women (DMH), Colombo 08, LK
About U.
Consultant Resident Physician, Resident Physician Unit
S. D. Pilapitiya,
Rajarata University of Sri Lanka, Saliyapura 50008, LK
About S. D.
Senior Lecturer and Consultant Physician, Department of Medicine, Faculty of Medicine and Allied Sciences
H. M. S. Senanayake
Rajarata University of Sri Lanka, Saliyapura 50008, LK
About H. M. S.
Senior Lecturer and Consultant Physician, Department of Medicine, Faculty of Medicine and Allied Sciences
Abstract
Background: Leptospirosis is a zoonotic disease with high prevalence in Sri Lanka predominantly in paddy cultivating areas. Severe leptospirosis is rarely described in pregnancy and there is a scarcity of data regarding its effect on pregnant patients. Acute lung injury has been recognized as the commonest fatal complication of leptospirosis. We report a case of delayed presentation of fulminant leptospirosis in a pregnant patient complicated with acute respiratory distress syndrome (ARDS) and severe coagulopathy resulting in death despite the optimum medical care.
Case Presentation: A-31-year-old woman in the twelfth-week of pregnancy admitted with a subacute history of frequent vomiting, dry cough, watery stools, vaginal spotting, hemoptysis, and progressive shortness of breath. She had tachycardia, hypotension, and acute severe respiratory distress with high-grade fever on admission. Her inflammatory markers were high with evidence of severe coagulopathy. With worsening clinical and biochemical parameters despite intensive medical intervention, patient had a fatal outcome. The autopsy revealed shock lung with multiple intra-alveolar hemorrhages. The serum Leptospira microscopic agglutination test (MAT) was positive confirming the fulminant leptospirosis.
Conclusion: Prolongrespiratory symptoms; positive lung signs with acute respiratory distress can mimic the clinical picture of atypical pneumonia. Delayed presentation of ARDS limits the management options whilst increasing the risk of fatality. A high degree of suspicion is needed to diagnose leptospirosis in pregnancy.
How to Cite:
Tharanga, U., Pilapitiya, S.D. and Senanayake, H.M.S., 2020. Fulminant Leptospirosis Leading to Shock Lung & Severe Coagulopathy in a Pregnant Patient: A Case Report and Review of the Literature. Journal of the Ruhunu Clinical Society, 25(1), pp.50–54. DOI: http://doi.org/10.4038/jrcs.v25i1.84
Published on
19 Dec 2020.
Peer Reviewed
Downloads