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Case Report: An Imported Case of Severe Leptospirosis with Septic Cardiomyopathy Requiring Venoarterial Extracorporeal Membrane Oxygenation in Japan

Takao GotoDepartment of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;

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Rentaro OdaDepartment of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;

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Yasuhiro NorisueDepartment of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan;

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Nobuo KoizumiDepartment of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan

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ABSTRACT.

A 29-year-old Japanese man presenting with fever, joint pain, and diarrhea was admitted to the intensive care unit for cardiogenic and distributive shock. We suspected leptospirosis based on conjunctival hyperemia, skin rash, elevated bilirubin, and renal involvement; a travel history to Laos was also suggestive. We confirmed the diagnosis with blood and urine polymerase chain reaction and microscopic agglutination tests using paired serum samples. His hemodynamics were unstable, and his echocardiogram showed diffuse and severe left ventricular systolic dysfunction on day 2. He initially required venoarterial extracorporeal membrane oxygenation (V-A ECMO) support but responded and recovered on antimicrobial therapy. His cardiac function and hemodynamics improved on day 5. Severe leptospirosis may cause jaundice, renal failure, pulmonary hemorrhage, acute respiratory distress syndrome, and central nervous system involvement; however, few studies have reported severe cardiac manifestations. Herein, we report the first case of septic cardiomyopathy secondary to leptospirosis that was successfully managed with V-A ECMO. Leptospirosis should be included in the differential diagnosis when a patient returning from an endemic area presents with cardiogenic shock. Furthermore, intensive care management with prompt initiation of V-A ECMO should be considered to reverse septic cardiomyopathy.

Author Notes

Address correspondence to Rentaro Oda, Department of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba 279-0001, Japan. E-mail: rentaroda@gmail.com

Authors’ addresses: Takao Goto and Yasuhiro Norisue, Department of Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan, E-mails: takao.0222.12@gmail.com and norisue.yasuhiro@gmail.com. Rentaro Oda, Department of Infectious Diseases, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan, E-mail: rentaroda@gmail.com. Nobuo Koizumi, Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan, E-mail: nkoizumi@niid.go.

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