Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by lep
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CASE REPORT
Open Access
Veno-venous extracorporeal membrane oxygenation successfully treated a case of severe pulmonary hemorrhage caused by leptospirosis H. J. Wang* , G. Z. Chen, C. J. Zhou, Y. FU and L. N. YAO
Abstract Background: Pulmonary hemorrhage is an important complication of leptospirosis. Once acute respiratory distress syndrome (ARDS) occurs as a secondary condition, treatment is extremely difficult and the mortality rate is very high. Case presentation: The patient was a 49-year-old. He was admitted to the hospital because he had experienced a fever and cough for 4 days. Hemorrhage, respiratory failure, ARDS and other symptoms appeared soon after admission. Due to severe pulmonary hemorrhage secondary to ARDS, mechanical ventilation was performed through tracheal intubation. During intubation, the patient suffered cardiac arrest, and the patient’s condition worsened. He was confirmed to have leptospirosis through second-generation sequencing of the alveolar lavage fluid. Finally, we successfully treated the patient with penicillin as an anti-infective medication and venous-venous extracorporeal membrane oxygenation (v-vECMO). To the best of our knowledge, this report is the first to describe the successful application of ECMO in mainland China. Conclusions: Leptospirosis can induce serious but transient ARDS with a better prognosis than other causes of ARDS. Our patient was successfully treated with V-vECMO. Keywords: Leptospirosis, Pulmonary hemorrhage, ARDS, ECMO, Case report
Background Leptospirosis is a zoonotic infectious disease caused by Leptospira. Leptospiral infection has a broad spectrum of clinical manifestations, ranging from a subclinical or mild illness to a fulminant life-threatening illness. Symptoms suggesting leptospirosis are non-specific but usually include fever, headache and myalgia, sometimes with hemorrhage or meningitis as the initial presentation [1, 2], and the disease has an average mortality rate of * Correspondence: [email protected] Department of Intensive Care Unit, the Affiliated People’s Hospital of Ningbo University, 251 East Baizhang Road, Ningbo City 315010, Zhejiang Province, P.R. China
6.85%. However, once complicated by pulmonary hemorrhage secondary to acute respiratory distress syndrome (ARDS), the mortality rate increases to 51 to 100% due to the lack of effective treatment [3, 4]. Use ECMO as a potential treatment modality with leptospirosis is increasing. However, this method requires advanced technology and is expensive. Currently, case reports are scarce and have not been widely conducted, particularly in developing countries. To our knowledge, no similar studies have been conducted in mainland China, particularly in patients with secondary cardiac arrest. The report of the successful treatment of secondary cardiac arrest induced by severe intravenous
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any
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