Coupled plasma filtration-adsorption in Weil's syndrome: case report

Weil's syndrome is a form of leptospirosis characterized by jaundice, renal failure and hemorrhagic diathesis. Its pathogenesis is related with the invasiveness of leptospires and with the subsequent systemic inflammatory response. Coupled plasma filtration-adsorption (CPFA) is a modality of extracorporeal blood purification in which plasma is separated from the whole blood and directed into a sorbent cartridge. Due to the ability of the sorbent agent to remove cytokines, CPFA has been proposed as an adjuvant treatment in septic shock. We report the case of a 27-year-old man with Weil's syndrome who was admitted to ICU with hypotension and anuria refractory to fluid therapy, ARDS, and hepatic involvement. The man needed intubation, mechanical ventilation and vasopressor infusion. CPFA was started early after the onset of shock. Five courses of CPFA were performed. Each course lasted for 10 h with 14 h interval. Weaning from vasopressors was achieved during the second course of CPFA (day 2 after admission). Weaning from ventilation was achieved on day 6. Interestingly, diuresis started during the first course of CPFA, with a creatinine clearance of 63 ml/min on day 8 and a normalization of the ratio urinary to plasma osmolality on day 28. The patient was discharged on day 11 and 28 from the Intensive Care Unit and hospital respectively.