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Cerebral infarct induced by severe leptospirosis-a case report and literature review
Zhongli Zhu1, Jian Feng1, Yong Dong2
1Department of critical care medicine, The General Hospital of Western Theater Command, 270 Tianhui Road, Chengdu, Sichuan, 610083, China.
Insights
Severe leptospirosis can cause cerebral infarction, a rare but deadly complication. This case highlights the importance of recognizing neurological manifestations in patients with leptospirosis, even in milder forms.
Area of Science:
- Infectious Diseases
- Neurology
- Critical Care Medicine
Background:
- Leptospirosis, a zoonotic disease, presents with diverse clinical manifestations, ranging from mild febrile illness to severe multi-organ complications.
- Severe leptospirosis carries a high fatality rate (>50%), even with intensive care unit (ICU) support.
- While cerebral arteritis is documented, cerebral infarction as a complication of leptospirosis is infrequently reported.
Approach:
- A case report of a 79-year-old male admitted to the ICU with fever, bloody sputum, and dyspnea following rice harvesting in flooded fields.
- Leptospira interrogans DNA was identified in bronchoalveolar lavage fluid (BALF) using next-generation sequencing (NGS).
- Microscopic agglutination test (MAT) revealed elevated serum antibodies against Mini and Hebdomadis serovars.
Key Points:
- The patient developed left hemiplegia on the eighth day of admission.
- Cranial CT scan confirmed cerebral infarction in the right basal ganglia.
- Despite treatment including penicillin, mechanical ventilation, and renal replacement therapy, the patient's condition deteriorated, leading to death.
Conclusions:
- Neurologic leptospirosis can manifest as cerebral occlusion.
- This rare complication of leptospirosis is potentially fatal and warrants clinical attention.
- Early recognition and management of neurological symptoms in leptospirosis are crucial.
Background:
Although most leptospirosis is mild, the severe form can cause multiple complications, with a fatality rate of over 50% even with ICU support. The clinical manifestations of leptospirosis vary depending on organs and tissues involved. Both cerebral artery and coronary artery can be damaged by leptospirosis. Although cerebral arteritis induced by leptospirosis has been reported, cerebral infarction caused by leptospirosis is rarely reported.
Case Presentation:
We report the case of a 79-year-old man admitted to intensive care unit (ICU) because of 3 days duration of fever, bloody sputum and dyspnea. Five days before he was admitted to hospital, he had harvested rice in flooded fields. After admission, leptospira interrogans DNA sequence was identified in bronchoalveolar lavage fluid (BALF) by next-generation sequencing (NGS). Microscopic agglutination test (MAT) showed the serum antibody of Mini serovars was 1,600 and Hebdomadis serovars was 800. On the eighth day of admission, the patient noted left hemiplegia. Cranial CT scan revealed low-density shadow in the right basal ganglia, so cerebral infarction was diagnosed. The patient's condition rapidly deteriorated and he died on the eleventh day of admission despite penicillin treatment, invasive mechanical ventilation and continuous renal replacement support.
Conclusion:
Neurologic leptospirosis manifested as cerebral occlusion, although rare, might be deadly and should not be ignored.
