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Published on: July 1, 2012
Liver Transplantation for Acute Liver Failure Attributed to Leptospirosis: A Report of Two Cases
Thibault Lebreton1, Fréderic Aubrun1, Jean-Yves Mabrut2
1Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Anesthésie Réanimation, 103 Grande Rue de la Croix-Rousse, 69004 Lyon Cedex, France.
Background:
Leptospirosis is a zoonosis caused by pathogenic spirochetes of the genus Leptospira. Although it may be limited to nonspecific fever, leptospirosis may also be responsible for neurological symptoms or fulminant diseases such as Weil's disease. Diagnosis is challenging due to the difficulty in isolating the organism and the delays required for performing the serological test.
Case Presentation:
Two cases of leptospirosis are presented here. The clinical picture differed from a real Weil's disease in the first case and from a neuro-leptospirosis in the second. However, both patients underwent liver transplantation because of the severity of the associated acute liver failure. Unfortunately, one of the cases had a fatal outcome.
Conclusion:
Antibiotic treatment for leptospirosis should not be delayed by the lack of a positive serology test for this potentially lethal disease. In the context of a history of exposure to risk factors for leptospirosis, a negative serology must be repeated 7 days to 2 weeks following the first test. Although not always present, acute liver injury may, in rare cases, require liver transplantation.
Insights
Early antibiotic treatment for leptospirosis is crucial, even with negative serology, to prevent severe outcomes like liver failure. Prompt diagnosis and repeated testing aid in managing this potentially fatal zoonotic disease.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Leptospirosis, a zoonotic disease caused by Leptospira, presents with diverse symptoms, ranging from mild fever to severe Weil's disease.
- Diagnostic challenges include difficulties in organism isolation and delayed serological test results.
- Leptospirosis can lead to severe complications, including neurological symptoms and acute liver failure.
Observation:
- Two cases of leptospirosis are presented, with atypical clinical presentations.
- Both patients experienced severe acute liver failure requiring liver transplantation.
- One patient had a fatal outcome despite medical intervention.
Findings:
- Delayed serological testing can hinder timely diagnosis of leptospirosis.
- Acute liver injury, though not always present, can be a severe manifestation requiring liver transplantation.
- Prompt antibiotic administration is vital for managing potentially lethal leptospirosis.
Implications:
- Emphasizes the need for early antibiotic treatment in suspected leptospirosis cases, irrespective of initial serological results.
- Highlights the importance of repeated serological testing to confirm diagnosis.
- Underscores that acute liver failure in leptospirosis may necessitate liver transplantation.
