A Leptospirosis Case Presenting with Thrombotic Thrombocytopenic Purpura
A Leptospirosis Case Presenting with Thrombotic Thrombocytopenic Purpura
Background:Leptospirosis is a zoonotic disease caused by spirochetes of the genus Leptospira. While the majority of leptospirosis cases occur in the tropics, some cases are also observed in temperate regions of developing countries. The disease has various clinical presentations ranging from a mild influenza-like form to a severe potentially fatal illness accompanied by multi-organ failure. However, atypical presentations of leptospirosis have occasionally been described. Here, a case of leptospirosis presenting as thrombotic thrombocytopenic purpura (TTP) is reported.Case Report: A 58-years-old male presented with fever, oliguria, darkening of urine, and visual hallucinations. Laboratory investigations revealed anaemia, severe thrombocytopaenia, elevated total bilirubin with indirect predominance, high lactate dehydrogenase, and increased urea (293 mg/dL) and creatinine (7.6 mg/dL) levels. He was diagnosed with TTP. Patient was thought leptospirosis due to atypical clinical manifestations. Leptospirosis was confirmed by strongly positive Microscopic Agglutination Test. Patient recovered completely with antibiotics and plasmapheresis.Conclusion: Leptospirosis may be accompanied by thrombotic thrombocytopenic purpura in particular subtropic regions.
___
- 1. Levett PN, Haake DA. Leptospirosis. In Mandell GL, Bennett JE, Dolin R, editors. Infectious Diseases. Philadelphia: Churchill Livingstone Elsevier Press. 2010;3059-3065.
- 2. Acha, PN, Szyfres B. Leptospirosis. In 3rd Pan American Health Organization, edition. Zoonoses and Communicable Disease Common to Man and Animals, Washington: PAHO Press. 2001;157.
- 3. Jena AB, Mohanty KC, Devadasan N. An outbreak of leptospirosis in Orissa, India:the importance of surveillance. Trop Med Int Health 2004;9:1016-21. [CrossRef]
- 4. Katz AR, Ansdell VE, Effler PV, Middleton CR, Sasaki DM. Assesment of the clinical presentation and treatment of 353 cases of laboratory-confirmed leptospirosis in Hawaii, 1974-1998. Clin Infect Dis 2001;33:1834-41. [CrossRef]
- 5. Tse KC, Yip PS, Hui KM, et al. Potential benefit of plasma exchange in treatment of severe icteric leptospirosis complicated by acute renal failure. Clin Diagn Lab Immunol 2002;9:482-4.
- 6. George JN, Vesely SK. Thrombotic thrombocytopenic purpurahemolytic uremic syndrome:diagnosis and treatment. Cleve Clin J Med 2001;68:857-58. [CrossRef]
- 7. Hoffman R, Benz EJ, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlave P, eds. thrombocytopenic purpura and the hemolytic uremic syndrome. In:Hematology Basic Principles and Practice. 4th ed. Philadelphia: Elsevier Churchill Livingstone;2005;p:2287-2304.
- 8. Farr RW. Leptospirosis. Clin Infect Dis 1995;21:1-6. [CrossRef]
- 9. Turhan V, Polat E, Murat Atasoyu E, Ozmen N, Kucukardali Y, Cavuslu S. Leptospirosis in Istanbul, Turkey:a wide spectrum in clinical course and complications. Scand J Infect Dis 2006;38:845-2. [CrossRef]
- 10. Edwards CN, Nicholson GD, Hassel TA, Everard CO, Callender J. Thrombocytopenia in leptospirosis:the absence of evidence for disseminated intravascular coagulation. Am J Trop Med Hyg 1986;35:352-4.
- 11. Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet 2005;365:1073-86. [CrossRef]
- 12. Gervasoni C, Ridolfo AL, Vaccarezza M, Parravicini C, Vago L, Adorni F, et al. Thrombotic microangiopathy in patients with acquired immunodeficiency syndrome before and during the era of introduction of highly active antiretroviral therapy. Clin Infect Dis 2002;35:1534-40. [CrossRef]
- 13. Begue R, Dennehy PH, Peter G. Hemolytic uremic syndrome associated with Streptococcus pneumoniae. N Engl J Med 1991;325:133-4. [CrossRef]
- 14. Laing RW, Teh C, Toh CH. Thrombotic thrombocytopenic purpura (TTP) complicating leptospirosis:a previously undescribed association. J Clin Pathol 1990;43:961-2. [CrossRef]
- 15. George JN. Clinical practice. Thrombotic thrombocytopenic purpura. N Engl J Med 2006;354:1927-35. [CrossRef]