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Case Reports in Critical Care
Volume 2017, Article ID 5369267, 5 pages
https://doi.org/10.1155/2017/5369267
Case Report

A Case of Leptospirosis-Associated Severe Pulmonary Hemorrhagic Syndrome Successfully Treated with Venovenous Extracorporeal Membrane Oxygenation

Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan

Correspondence should be addressed to Shingo Ichiba; moc.liamg@ognihsomce

Received 12 June 2017; Revised 17 September 2017; Accepted 2 October 2017; Published 25 October 2017

Academic Editor: Chiara Lazzeri

Copyright © 2017 Nao Umei and Shingo Ichiba. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. In patients with leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS), hypoxemia is the most common cause of death despite maximal mechanical ventilation. Case. A 50-year-old male sushi chef who had never traveled outside Japan presented with a 2-day history of fever and muscle pain. On admission, the patient had thrombocytopenia, renal insufficiency, and jaundice. His condition continued to deteriorate, with decreasing platelet count, worsening renal function, hyperbilirubinemia, hypotension, and respiratory distress. On day 5 after onset of symptoms, he required intubation and mechanical ventilation. Bronchoscopy showed diffuse endobronchial bleeding. His respiratory status worsened rapidly with a partial pressure of arterial oxygen to fraction of inspired oxygen ratio of 70, necessitating venovenous extracorporeal membrane oxygenation (V-V ECMO) and treatment with an inotrope, renal replacement therapy, and broad-spectrum antibiotics including benzylpenicillin. Anticoagulation was maintained at the minimum level. His condition improved, and he was weaned off ECMO on day 15 and discharged on day 19 after onset of symptoms. The leptospirosis diagnosis was confirmed by leptospiral DNA detection in urine samples by polymerase chain reaction and the results of paired serum antibody titer testing. Conclusions. V-V ECMO may prevent mortality in patients with leptospirosis-induced SPHS that does not respond to conventional therapy.