Ekinci F, Yıldızdaş RD, Horoz ÖÖ, Alabaz D, Tolunay İ, Petmezci E. Treatment of severe
leptospirosis with therapeutic
plasma exchange in a pediatric patient. Turk J Pediatr 2018; 60: 566-570.
Leptospirosis is a common
zoonotic disease caused by spirochetes of the genus Leptospira. Although it is mostly a tropical disease, some case reports have been published from temperate regions of the world. The disease presents with a wide spectrum; from asymptomatic self limited disease to a fatal illness characterized by multi-organ involvement. An 8-year-old girl presented with a 5-day history of
fever,
myalgia,
fatigue,
vomiting and
diarrhea. She developed
anuria,
hypotension and became unconscious one day after admission and was referred to our pediatric intensive care unit for further evaluation and treatment. Initial physical examination revealed
fever,
jaundice, diffuse petecchiae on whole body,
hepatomegaly and severe
hypotension. Laboratory investigations showed elevated liver
enzymes and
bilirubin levels, elevated
creatinine and
creatine kinase levels and trombocytopenia. The diagnosis of
Leptospirosis was detected by rapid
IgM test and confirmed by microscopic agglutination test later. She was treated with
mechanical ventilation, wide spectrum
antibiotics, positive inotropic agents and
penicillin G plus two days of
continuous renal replacement therapy and five sessions of therapeutic
plasma exchange performed daily. She recovered completely and was transferred to the pediatric ward on the 14th day of hospitalization. The exact role of therapeutic
plasma exchange has not been well documented yet, it seems to have benefical effects on clinical and laboratory findings and survival as we observed in our patient and learned from experiences in adult patients presented as case reports.