# Severe neurological complications of leptospirosis, presentation of two cases

## TL;DR

This paper presents two cases of severe neurological complications in leptospirosis patients, highlighting the impact on the nervous system and treatment approaches.

## Contribution

The paper emphasizes the role of inflammatory responses in causing neurological complications and suggests corticosteroids as a potential treatment.

## Key findings

- Leptospirosis can cause neurological symptoms like polyradiculitis and intracranial microhemorrhages.
- Inflammatory reactions, not the infection itself, may lead to severe complications.
- Corticosteroids may improve outcomes in immune-mediated neurological symptoms.

## Abstract

We discuss two cases of severe leptospirosis, in which the most concerning symptoms affected the nervous system. These cases illustrate the wide range of neurological symptoms that can be seen in patients with leptospirosis, which can affect both the central and peripheral nervous system. These symptoms are thought to be caused by an inflammatory reaction to Leptospira, rather than by the infection itself. Both patients experienced a variety of neurological symptoms that prolonged and altered their course of treatment. The first patient developed radicular pain secondary to polyradiculitis, which was confirmed by spinal MRI. He was treated with antibiotics but continued to experience bilateral leg pain following treatment. He was referred to a rehabilitation clinic to help him deal with his persisting complaints. The second patient was admitted to the intensive care unit and failed to regain consciousness after sedation was discontinued. Neuroimaging revealed multiple intracranial microhemorrhages. He was treated with antibiotics in combination with corticosteroids. Following extensive rehabilitation, he recovered without residual neurological deficits.

•Patients with leptospirosis can develop a range of neurological symptoms.•Inflammatory response can cause a cytokine storm, and lead to severe complications.•These include polyradiculitis and intracranial microhemorrhages.•Corticosteroids might be indicated in immune-mediated symptoms and improve outcome.

Patients with leptospirosis can develop a range of neurological symptoms.

Inflammatory response can cause a cytokine storm, and lead to severe complications.

These include polyradiculitis and intracranial microhemorrhages.

Corticosteroids might be indicated in immune-mediated symptoms and improve outcome.