# A case report of leptospirosis complicated by severe pulmonary hemorrhage treated with venovenous extracorporeal membrane oxygenation

## TL;DR

A 57-year-old woman with severe leptospirosis and lung bleeding was successfully treated with a new combination of ECMO and immunomodulatory therapy.

## Contribution

This is the first reported case combining VV-ECMO with lymphoplasmacyte exchange in leptospiral pulmonary hemorrhage syndrome.

## Key findings

- Early VV-ECMO initiation improved outcomes in a patient with severe leptospirosis-induced pulmonary hemorrhage.
- Combining VV-ECMO with lymphoplasmacyte exchange may offer a new treatment approach for LPHS.
- Individualized anticoagulation and immunomodulatory therapy were critical in managing this complex case.

## Abstract

Leptospirosis is a zoonotic disease with diverse clinical manifestations, and its severe form can lead to life-threatening complications such as pulmonary hemorrhage. We present a novel case of a 57-year-old woman with leptospirosis who developed severe pulmonary hemorrhage and acute respiratory distress syndrome (ARDS) and was successfully managed with early venovenous extracorporeal membrane oxygenation (VV-ECMO), minimal anticoagulation, and lymphoplasmacyte exchange (LPE). This case highlights the importance of early ECMO initiation, individualized anticoagulation, and immunomodulatory therapy in improving outcomes for patients with leptospiral pulmonary hemorrhage syndrome (LPHS), a condition with mortality exceeding 50%. To our knowledge, this is the first reported case combining VV-ECMO with LPE in LPHS, offering a new therapeutic paradigm for critically ill patients at the intersection of infection and autoimmunity.