Massive rhabdomyolysis and multiple organ dysfunction syndrome caused by leptospirosis |
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Authors: | D B Coursin S J Updike D G Maki |
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Institution: | (1) Department of Anesthesiology, University of Wisconsin Medical School, Madison, WI 53792, USA e-mail: dcoursin@facstaff.wisc.edu Tel.: + 1-6 08-2 63 91 31 Fax: + 1-6 08-2 63 05 75, US;(2) Department of Medicine, University of Wisconsin Medical School, Madison, WI 53792, USA, US;(3) Center for Trauma and Life Support, University of Wisconsin Medical School, Madison, WI 53792, USA, US |
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Abstract: | We report a case of leptospiral infection in a 63-year-old man who acquired the infection while swimming in canals and streams
in Hawaii. The patient's course was atypical in that he was anicteric and had no evidence of meningitis when he presented
with fever, rapidly progressive and severe rhabdomyolysis, thrombocytopenia, acute renal failure, and respiratory distress
syndrome. Although he recovered after a protracted illness, he required major life support, including mechanical ventilation
and hemodialysis. Initial antimicrobial therapy was designed to cover major bacterial and atypical pathogens, including leptospires.
An in-depth work-up for causes of this catastrophic illness confirmed acute leptospirosis. Although rare, leptospirosis is
a potentially lethal infection classically associated with hepatitis, azotemia, and meningitis. Most patients experience self-limited
illness, with fever, myalgias, and malaise followed by an immune-mediated aseptic meningitis. A small proportion develop shock
and multiple organ dysfunction. Whereas myalgias are ubiquitous in leptospiral infection, and most patients show mildly elevated
muscle enzymes, life-threatening rhabdomyolysis is rare. This atypical case is reported to urge clinicians to consider leptospirosis
in the evaluation of a patient with cryptogenic sepsis who develops multiple organ dysfunction associated with rhabdomyolysis.
Appropriate antimicrobial therapy, with penicillin or doxycycline, can be life-saving.
Received: 24 November 1999 Final revision received: 15 February 2000 Accepted: 7 March 2000 |
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Keywords: | Acute renal failure Acute respiratory failure Atypical pneumonia Leptospirosis Multiple organ dysfunction syndrome Rhabdomyolysis |
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