# Bowel Necrosis in Leptospirosis: A Case Series of a Rare Complication

## TL;DR

This paper reports two cases of severe leptospirosis complicated by rare bowel necrosis, highlighting the importance of early recognition of gastrointestinal symptoms.

## Contribution

The novelty lies in documenting rare gastrointestinal complications, specifically bowel necrosis, in severe leptospirosis cases.

## Key findings

- Severe leptospirosis can lead to terminal ileal and colonic necrosis.
- Gastrointestinal symptoms in leptospirosis may indicate severe disease requiring urgent intervention.
- Despite aggressive treatment, patients with bowel necrosis in leptospirosis may have fatal outcomes.

## Abstract

Leptospirosis, a globally prevalent zoonotic disease, exhibits diverse clinical manifestations, often with severe multiorgan involvement. Gastrointestinal complications are uncommon, but their potential severity and impact on patient outcomes warrant attention. We present two cases of severe leptospirosis complicated by terminal ileal and colonic necrosis.

Two patients presented with acute febrile illness, severe myalgia, oliguria, and hypotension. Both had occupational exposure to paddy fields, a known risk factor for leptospirosis. Based on clinical presentation and laboratory findings (acute kidney injury, myocarditis, and acute severe pulmonary hemorrhagic syndrome), a diagnosis of severe leptospirosis was established. Development of proximal bowel obstruction and melena in the third week of illness indicated severe gastrointestinal involvement. Both patients received intensive care support, including broad-spectrum antibiotics, inotropes, and renal replacement therapy. One patient underwent exploratory laparotomy for bowel perforation. Despite aggressive management, both patients succumbed to the disease.

Gastrointestinal complications, including bowel necrosis and perforation, can occur in severe leptospirosis. Early recognition and management of gastrointestinal symptoms are crucial. Further research is needed to understand the pathophysiology of this rare but fatal complication.