The Role of Plasmapheresis in Severe Leptospirosis Refractory to Standard Therapy: A Case Report and a Comprehensive Literature Review

TL;DR

This paper reports a case where plasmapheresis helped a patient with severe leptospirosis who did not respond to standard treatments.

Contribution

The study presents plasmapheresis as a potential rescue therapy for severe leptospirosis unresponsive to conventional treatment.

Findings

Plasmapheresis led to marked clinical and laboratory improvements in a patient with severe leptospirosis.

Plasma exchange effectively reduced bilirubin levels in a patient unresponsive to antibiotics and hemodialysis.

Abstract

Leptospirosis, a zoonotic infection prevalent in Pakistan, presents diverse clinical manifestations ranging from mild flu-like symptoms to severe multiorgan failure known as Weil’s disease. This case study reports on a 24-year-old woman with leptospirosis complicated by acute kidney injury and hyperbilirubinemia, unresponsive to standard therapies. Despite initial treatment with antibiotics and hemodialysis, her condition deteriorated. Following a single session of plasmapheresis, marked clinical and laboratory improvements were observed. Notably, plasma exchange effectively reduced bilirubin levels, underscoring its potential benefit in severe leptospirosis. This case highlights the role of plasmapheresis as rescue therapy in critically ill patients, demonstrating significant outcomes in cases resistant to conventional management. Further research is warranted to refine guidelines on the optimal timing and frequency of plasma exchange in such settings.