Case Report

Haemophagocytic Lymphohistiocytosis with Leptospirosis: A Rare but Devastating Complication

Table 2

Review of reported cases of sHLH following leptospirosis.

Yang et al. [6]Sripanidkulchai and Lumbiganon [7]Rajagopala et al. [8]Krishnamurthy et al. [9]Kodan et al. [10]Barman et al. [11]Jevtic et al. [12]Our patient (2021)

Age (years)618.653424401374

SexFemaleMaleFemaleMaleMaleMaleFemaleMale

CountryTaiwanThailandIndiaIndiaIndiaIndiaSerbiaSri Lanka

ComorbiditiesType 2 DM for 4 years, psoriasis vulgaris for 10 yearsNANANoneNANoneNoneType 2 DM, hypertension

Presentation4-day history of abdominal pain, malaise, diarrhoea, and intermittent feverFever >37.8°C for more than 6 daysFever, delirium, purpura for 10 daysHigh-grade fever for 7 daysFever and oliguriaHigh-grade fever for 10 days, yellowish discolouration of the eyes and urine for 4 days, recurrent nasal bleeding for 2 daysA 20-day history of fever, swelling, and neck pain following a rashHigh-grade fever for 7 days

Diagnostic criteria for sHLHFever: 39°C, splenomegaly, WBC: 1900, Hb: 10.1, TG-: 414, S. ferritin: 9152, BM biopsy: HSFever, leukopenia, thrombocytopeniaFever, organomegaly, TG: 366, S. ferritin: 16,192, BM aspiration: HSFever, organomegaly, TG: 658, S. ferritin: 1329, BM biopsy: HSFever, organomegaly, cytopaenia, S. ferritin: 6360, BM biopsy: HS, TG: NAFever >39°C, organomegaly, WBC: 1500, Hb: 6.5, TGL 525, S. ferritin: 1400, BM biopsy: HSFever, organomegaly, Hb: 9.4, Plt: 63,000, S. ferritin: 1500, BM biopsy: HS, soluble interleukin-2R alphaFever >38.5 C, Hb: 7.8 g/dl, Plt <40,000, organomegaly, S. ferritin: 60,685, TG: 358, BM biopsy: HS

ManagementCeftriaxone, metronidazole, day 07: oral doxycycline, intermittent haemodialysisNASteroids, antimicrobials, mechanical ventilation, vasopressorsCeftriaxone and prednisoloneCorticosteroidsCeftriaxone, doxycycline, methylprednisoloneMeropenem and cefuroxime, IVIG, corticosteroids, haemodialysisCeftriaxone, methylprednisolone/dexamethasone, etoposide, intermittent haemodialysis, lung-protective ventilation

ComplicationsAKI deteriorating liver functions, generalized seizures, comaAscites, pericardial effusion, cardiogenic shockAKI, ARDS, fulminant hepatic failureNANARefractory hypotension, pancytopaenia, progressive hypoxemia requiring mechanical ventilationAKIAKI, severe ARDS, pulmonary haemorrhages

Number of hospital days122173 weeksNA123508

OutcomeDeathResponded to therapyDeath following CRBSIResponded well to the treatment; haematological and biochemical derangements normalized at one yearResponded to therapyDeath following cardiac arrestFull recoveryDeath following cardiac arrest

DM: diabetes mellitus; NA: not available; WBC: white blood cells; Hb: haemoglobin; TG: triglycerides; Plt: platelets; S. ferritin: serum ferritin; BM biopsy: bone marrow biopsy; HS: haemophagocytes; CRBSI: catheter-related blood stream infection; IVIG: intravenous immunoglobulin; AKI: acute kidney injury; ARDS: adult respiratory distress syndrome.