Leptospirosis manifested with severe pulmonary hemorrhagic syndrome successfully treated with veno-venous extracorporeal membrane oxygenation: A case report and literature review

Rationale:The mortality rate associated with pulmonary hemorrhage induced by leptospirosis is notably high. Available treatment modalities are limited, and their efficacy has not been fully demonstrated. Here, we present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. A 49-year-old male patient was admitted to the Surgical Ward of the Department of Intensive Care Medicine of Fuyang Infectious Disease Clinical College of Anhui Medical University. The patient had initially sought medical attention at a local hospital due to symptoms of fever persisting for 4 days and chest tightness accompanied by hemoptysis for 1 day.Patient concerns:We present the case report of a patient with leptospirosis-induced pulmonary hemorrhagic syndrome. Hemoptysis persisted in our patient during VV-ECMO, although we adjusted the heparin regimen to maintain an activated partial thromboplastin time target value of 50 to 55 seconds.Diagnoses:Leptospirosis-induced pulmonary hemorrhagic syndrome.Interventions:He was immediately intubated and mechanically ventilated and then transferred to our hospital for further medical intervention. Upon arrival at our hospital, he was treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO). Consequently, he was administered penicillin and omacycline for anti-infective therapy. Anti-inflammatory agents, high-dose vasoactive drugs to enhance blood pressure, continuous renal replacement therapy, tracheal sputum aspiration, and ventilator-assisted ventilation were also administered as part of the treatment protocol.Outcomes:After treatment, his inflammation index was significantly decreased, the amount of pulmonary bleeding was reduced, his oxygenation ratio was improved, and the pulmonary lesions were absorbed. Consequently, he was discharged on the 34th day of hospitalization.Lessons:We successfully treated a case of leptospirosis pulmonary hemorrhagic syndrome using VV-ECMO combined with prudent anticoagulant therapy.