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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
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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
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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
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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.

DOI: https://doi.org/10.4038/jrcs.v25i1.84
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

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