Morbidity and mortality due to cerebral edema complicating the treatment of severe leptospiral infection.

Although neurological signs and symptoms are well described in leptospiral infections, cerebral edema has not been reported previously. We have encountered two patients with severe leptospiral infection, associated with multisystem involvement, who developed cerebral edema. Both patients were in acute oligoanuric renal failure, one being treated by acetate hemodialysis and the other by hemofiltration. Grand mal seizures developed in both patients, followed by respiratory, then cardiac arrest, as a consequence of dialytic therapy. Only one patient could be resuscitated and he was left with a hemiparesis. Cerebral edema may develop in patients with severe leptospiral infections consequent to treatments used in the management of renal failure.