Medicine · 2026
Veno-venous extracorporeal membrane oxygenation support for severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome: A case report and literature review.
СтатьяКлинический случайОбзорНазвание и аннотация: Перевод в очереди
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Li Xinyi, Wen Hui, Wen Fang, Liu Zhao
Аннотация
RATIONALE: Leptospiral pulmonary hemorrhage syndrome is a rare but life-threatening manifestation of leptospirosis and is frequently complicated by acute respiratory distress syndrome, with persistently high mortality. Using veno-venous extracorporeal membrane oxygenation (VV-ECMO) in this setting remains challenging because systemic anticoagulation may exacerbate pulmonary bleeding.
PATIENT CONCERNS: A 58-year-old male farmer presented with high fever, myalgia, and rapidly progressive dyspnea following possible environmental exposure. He developed severe hypoxemia accompanied by diffuse pulmonary hemorrhage and multi-organ dysfunction.
DIAGNOSES: According to clinical presentations, radiologic findings, and next-generation sequencing of peripheral blood, the diagnosis of severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome was established.
INTERVENTIONS: Despite lung-protective mechanical ventilation and adjunctive prone positioning, hypoxemia persisted. VV-ECMO was initiated as rescue therapy using an individualized anticoagulation strategy. Continuous renal replacement therapy with regional citrate anticoagulation was employed to minimize systemic anticoagulant exposure. Pathogen-directed antimicrobial therapy was promptly instituted following microbiological confirmation.
OUTCOMES: The patient exhibited progressive improvement in oxygenation and organ function. VV-ECMO was successfully weaned after 6 days, followed by extubation and transfer out of the intensive care unit with stable respiratory status.
LESSONS: VV-ECMO may be considered a viable therapy for life-threatening hypoxemia in leptospiral pulmonary hemorrhage when the underlying disease is potentially reversible. Individualized anticoagulation strategies and continued application of lung-protective measures, including prone positioning when feasible, are critical to optimizing outcomes.
PATIENT CONCERNS: A 58-year-old male farmer presented with high fever, myalgia, and rapidly progressive dyspnea following possible environmental exposure. He developed severe hypoxemia accompanied by diffuse pulmonary hemorrhage and multi-organ dysfunction.
DIAGNOSES: According to clinical presentations, radiologic findings, and next-generation sequencing of peripheral blood, the diagnosis of severe leptospirosis complicated by pulmonary hemorrhage and refractory acute respiratory distress syndrome was established.
INTERVENTIONS: Despite lung-protective mechanical ventilation and adjunctive prone positioning, hypoxemia persisted. VV-ECMO was initiated as rescue therapy using an individualized anticoagulation strategy. Continuous renal replacement therapy with regional citrate anticoagulation was employed to minimize systemic anticoagulant exposure. Pathogen-directed antimicrobial therapy was promptly instituted following microbiological confirmation.
OUTCOMES: The patient exhibited progressive improvement in oxygenation and organ function. VV-ECMO was successfully weaned after 6 days, followed by extubation and transfer out of the intensive care unit with stable respiratory status.
LESSONS: VV-ECMO may be considered a viable therapy for life-threatening hypoxemia in leptospiral pulmonary hemorrhage when the underlying disease is potentially reversible. Individualized anticoagulation strategies and continued application of lung-protective measures, including prone positioning when feasible, are critical to optimizing outcomes.