Chest Infections: Chest Infections |

A Case Report of Leptospirosis With Extensive Alveolar Hemorrhage FREE TO VIEW

Yan Zhang, MD; Hongyi Tan, PhD; Xiaoli Su, PhD; Pinhua Pan, PhD; Tengjuan Xu, MD; Cheng-ping Hu, PhD; Ying Li, PhD; Haitao Li, MD
Author and Funding Information

Xiangya Hospital, Changsha, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A72. doi:10.1016/j.chest.2016.02.077
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SESSION TITLE: Chest Infections

SESSION TYPE: Case Report Slide

PRESENTED ON: Sunday, April 17, 2016 at 09:45 AM - 11:15 AM

INTRODUCTION: Severe pulmonary hemorrhagic leptospirosis (SPHL) emerged in recently years in severe leptospira infection is very rare[1]. We recently managed a case of leptosprosis involvement of alveolar hemorrhage treatment of bronchial artery embolism, antibiotic, high flow oxygen and proper support therapy.

CASE PRESENTATION: A 58-year-old male, who was agricultural field farmer developed high fever, cough and expectoration on July 20th in 2015. Initially, he was treated with antibiotic moxifloxacin by local practitioners as an outpatient basis. Meanwhile, he gradually developed steaky hemoptysis and given bronchial artery embolism because of massive hemoptysis on August 8th 2015, but he had still a haemoptysis. When he got admitted to Respiratory Intensive Care Unit of Xiangya Hospital, Initial arterial blood gas revealed type I respiratory failure with high flow oxygen of 15L/min (pH7.46, PCO2 28mmHg, HCO3-19.9mmol/l, PO2 68mmHg, SaO 294%). Routine blood picture showed leukocyte 21900/cu mm, neutrophilic leucocytosis 20000/cu mm. Other laboratory examinations appear normal. Bronchoscopy caught sight of bleeding of left upper lower lobe and right upper lobe (Figure 1). Chest X-ray revealed bilateral non-homogenous opacities in both middle and upper lung zones (Figure 2). Review CT thorax with clinical manifestations found that pulmonary hemorrhage progressed fast (Figure 3-4). Our experienced old professors suspected severe rare leptospirosis with alveolar hemorrhage and the serum IgM leptospira was done immediately, result of antibody titer was 1:1600 (cut-off: 1:400). Intravenous piperacillin-tazobactam started immediately. Within 72 h, the patient became afebrile and remarkablely reduced hemoptysis and rechecked CT thorax found that both lung lesions were improved markedly after 1 week (Figure 5). The patient recovered smoothly and discharged soon.

DISCUSSION: Leptospirosis has been under-reported and under-diagnosed from China. Most of leptospirosis causes wild symptoms and show spontaneous recovery without any specific therapy. Massive hemoptysis, representing extensive alveolar hemorrhage, is an ominous complication of leptospirosis associated with fatality rates >50 %[2] and rarely severe leptospirosis may develop ARDS with even more higher mortality rates. To our best knowledge, our case report, the patient with rare extensive alveolar hemorrhage, was delayed of diagnosis and it is the first case report to be treated with bronchial artery embolism in the early days, but the hemostatic effect was unsatisfactory.

CONCLUSIONS: Leptospirosis is under-reported and under-diagnosed from developing countries like China. Early diagnosis and management can prevent complications and mortality.

Reference #1: Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR. Leptospiral pneumonias. Curr Opin Pulm Med. 2007. 13(3):230-5.

Reference #2: Gouveia EL, Metcalfe J, de Carvalho AL, et al. Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil. Emerg Infect Dis. 2008. 14(3):505-8.

DISCLOSURE: Yan Zhang: Employee: $10000 Hongyi Tan: Employee: $10 The following authors have nothing to disclose: Xiaoli Su, Pinhua Pan, Tengjuan Xu, Cheng-ping Hu, Ying Li, Haitao li

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