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

• Published in: Balkan medical journal Vol. 33; no. 5; pp. 578 - 580
• Main Authors: Yesilbas, Osman, Kihtir, Hasan Serdar, Yildirim, Hamdi Murat, Hatipoglu, Nevin, Sevketoglu, Esra
• Format: Journal Article
• Language: English
• Published: Turkey Trakya Üniversitesi 01-09-2016; AVES; Galenos Publishing House
• Subjects: Case Report; Leptospirosis; macrophage activation syndrome; pericardial tamponade; sclerosing cholangitis; Tıp; Türkiye; Edirne; Leptospirosis; macrophage activation syndrome; pericardial tamponade; sclerosing cholangitis
• ISSN: 2146-3123; 2146-3131
• DOI: 10.5152/balkanmedj.2016.151240

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.
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.
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.